title: Increasing burden of melanoma in the United States.
abstract: It is controversial whether worldwide increases in melanoma incidence represent a true epidemic. Dramatic increases in incidence in the setting of relatively stable mortality trends have also been attributed to expanded skin screening and detection of biologically indolent tumors with low metastatic potential. To better understand how melanoma incidence trends varied by severity at diagnosis and factors relevant to screening access, we assessed recent United States incidence and mortality trends by histologic type, tumor thickness, and area-level socioeconomic status (SES). We obtained population-based data regarding diagnoses of invasive melanoma among non-Hispanic whites from nearly 291 million person-years of observation by the Surveillance Epidemiology and End Results (SEER) program (1992-2004). Age-adjusted incidence and mortality rates were calculated for SEER and a subset (California) for which small-area SES measure was available. Overall, melanoma incidence increased at 3.1% (P<0.001) per year. Statistically significant rises occurred for tumors of all histologic subtypes and thicknesses, including those >4 mm. Melanoma incidence rates doubled in all SES groups over a 10-year period whereas melanoma mortality rates did not increase significantly. We conclude that screening-associated diagnosis of thinner melanomas cannot explain the increasing rates of thicker melanomas among low SES populations with poorer access to screening.
authors.affiliation: Northern California Cancer Center, Fremont, California, USA. linos@stanford.edu
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
authors.forename: Myles G
authors.initials: MG
authors.lastname: Cockburn
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
mesh_terms: D017677:Age Distribution; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008545:Melanoma / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D018426:SEER Program; D012720:Severity of Illness Index; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American