title: The incidence and mortality of cutaneous melanoma in Southern Germany: trends by anatomic site and pathologic characteristics, 1976 to 2003.
abstract: BACKGROUND
  Cutaneous melanoma (CM) incidence and mortality have risen dramatically during the past 2 generations, particularly among Caucasian populations. Detailed, long-term trends of CM in relation to clinical and pathologic characteristics in a Central European population have not been published to date.
  
  
  METHODS
  The current study was based on 1980 patients with invasive CM diagnosed in Southern Germany during the years from 1976 to 2003 documented by the Central Malignant Melanoma Registry. The German standard population was used to calculate age-standardized rates, and the annual percent change was estimated by using age, anatomic site, histologic type, and tumor thickness.
  
  
  RESULTS
  During the study period, the incidence of CM approximately was tripled for males and females, reaching 10.3 and 13.3 per 100,000 per year, respectively (P < .001). The largest increases occurred for melanoma localized on the upper limbs (annual change, 5.9% for males and 5.0% for females; P < .001) and superficially spreading melanoma (annual change, 7.8% for males and 5.9% for females; P < .001). Thin tumors (Breslow thickness <1 mm) were presented significantly more often during the study period (annual change, 9.8% for males and 6.1% for females; P < .001), predominantly in younger patients. Thick tumors and nodular melanomas were more frequent among older patients (age >70 years), particularly among males. The age-standardized mortality decreased from 1.5 to 0.8 per 100,000 males and from 2.6 to 0.8 per 100,000 females with a significant downward trend for the female population (P < .001).
  
  
  CONCLUSIONS
  The current results indicated which diverging trends between incidence and mortality may be explained by improved public awareness regarding suspicious pigmented lesions and the earlier detection of these tumors. Continuation of the current preventive strategy and its expansion to include older age groups in the population are warranted.
authors.affiliation: Section of Dermatological Oncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, Eberhard-Karls University, Tuebingen, Germany.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Lasithiotakis
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Roman
authors.initials: R
authors.lastname: Gorkievicz
authors.forename: Thomas
authors.initials: T
authors.lastname: Eigentler
authors.forename: Helmut
authors.initials: H
authors.lastname: Breuninger
authors.forename: Gisela
authors.initials: G
authors.lastname: Metzler
authors.forename: Waltraud
authors.initials: W
authors.lastname: Strobel
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005121:Extremities; D005260:Female; D005858:Germany / Q000453:epidemiology; D006257:Head; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009333:Neck; D012042:Registries / Q000706:statistics & numerical data; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology