title: Incidence and survival in patients with cutaneous melanoma by morphology, anatomical site and TNM stage: a Danish Population-based Register Study 1989-2011.
abstract: BACKGROUND
  The incidence of melanoma of the skin has risen in Denmark in recent decades, the increase being steeper from 2004. It is unclear whether this represents a true rise in incidence or whether it is caused by an increased awareness of the condition.
  
  
  METHODS
  To assess whether the increase was characterised by early-stage melanomas and a higher proportion of melanomas with superficial spreading morphology, we studied all skin melanoma patients registered in the Danish Cancer Register 1989-2011 (n=27,010) and followed up for death through 2013. Trends in age-standardised incidence by sex, subsite and morphology, relative survival, TNM stage distribution and stage-specific relative survival from 2004 were analysed.
  
  
  RESULTS
  The incidence of melanoma more than doubled over 23 years. A steeper increase from 2004 was driven mainly by superficial spreading tumours, but the proportion of nodular melanomas in patients 50 years of age and over also increased significantly. The largest increase occurred for stage I tumours and for tumours on the trunk. From 1989-1993 to 2009-2011 the 5-year relative survival increased at 12% and 6% points for male and female patients, respectively.
  
  
  CONCLUSIONS
  Greater awareness, and thus lower stage at diagnosis (mediated by a large skin cancer prevention campaign from 2007), might explain part of the increase, but the increase in nodular melanoma also points to a genuine increase in the risk of melanoma.
authors.affiliation: The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: christiane.marie.bay@regionh.dk.
authors.forename: Christiane
authors.initials: C
authors.lastname: Bay
authors.affiliation: The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark. Electronic address: kejs@cancer.dk.
authors.forename: Anne Mette Tranberg
authors.initials: AM
authors.lastname: Kejs
authors.affiliation: The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark. Electronic address: hans@cancer.dk.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Storm
authors.affiliation: The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark. Electronic address: gerda@cancer.dk.
authors.forename: Gerda
authors.initials: G
authors.lastname: Engholm
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D015996:Survival Rate; D055815:Young Adult
keywords: Cancer register; Epidemiology; Incidence; Melanoma; Risk factors; Superficial spreading morphology; Survival; TNM stage; Time trends