title: The burden of malignant melanoma--lessons to be learned from Austria.
abstract: OBJECTIVE
  Incidence rates of melanoma, generated by cancer registries (CRs), are susceptible to reporting inconsistencies due to increasing decentralisation of diagnosis. We therefore independently assessed the burden of melanoma in Austria.
  
  
  METHODS
  We collected histopathological reports on melanoma of all patients diagnosed in Austria in 2011. Demographic and clinical characteristics, histopathological tumour stages were assessed. Their regional distributions and incidence rates were analysed and compared with data of national and international CRs.
  
  
  RESULTS
  A total of 5246 patients were diagnosed with 1951 in-situ and 3295 invasive melanomas in Austria in 2011 (population 8.4 million). Age, sex and anatomic distribution corresponded to findings in other European countries, however, the incidence of 25/100,000 (world age-standardised rate) for invasive melanomas was two-fold higher than published by the Austrian CR (12/100,000). Varying frequencies in diagnosing thin melanomas (≤1 mm; n = 4415) accounted exclusively for significant regional disparities, while advanced tumours (>1 mm; n = 761) were evenly distributed. Western Austria showed the highest rates (36/100,000). Patients from eastern Austria whose melanomas were diagnosed in laboratories in western Austria (n = 76) showed significantly higher proportions of in-situ lesions (n = 43; 57%) compared to those whose tumours were diagnosed in eastern Austria (n = 4014; in-situ = 1369; 34%) (p < 0.0001).
  
  
  CONCLUSIONS
  In Austria, the melanoma burden and its potential socio-economic implications are significantly underestimated. Similarities of incidences indicate this could affect other European countries with well-established CRs and compromise international comparability of data. Austrian regional disparities suggest overdiagnosis of thin melanomas due to the variability of pathologists' thresholds for the diagnosis of early stage tumours.
authors.affiliation: Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria.
authors.forename: Babak
authors.initials: B
authors.lastname: Monshi
authors.affiliation: Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria.
authors.forename: Marin
authors.initials: M
authors.lastname: Vujic
authors.affiliation: Centre for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University, Spitalgasse 23, A-1090 Vienna, Austria.
authors.forename: Danijel
authors.initials: D
authors.lastname: Kivaranovic
authors.affiliation: Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria.
authors.forename: Alma
authors.initials: A
authors.lastname: Sesti
authors.affiliation: Institute for Clinical Epidemiology, Anichstraße 35, A-6020 Innsbruck, Austria.
authors.forename: Willi
authors.initials: W
authors.lastname: Oberaigner
authors.affiliation: Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria; University of California San Francisco, Mt. Zion Cancer Research Center, 2340 Sutter Street N461, San Francisco, CA, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Vujic
authors.affiliation: University of California San Francisco, Mt. Zion Cancer Research Center, 2340 Sutter Street N461, San Francisco, CA, USA.
authors.forename: Susana
authors.initials: S
authors.lastname: Ortiz-Urda
authors.affiliation: Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria; Brigham and Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur #660, 02115 Boston, MA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Posch
authors.affiliation: Department of Pathology and Microbiology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria.
authors.forename: Hans
authors.initials: H
authors.lastname: Feichtinger
authors.affiliation: Austrian National Cancer Registry, Directorate Social Statistics, Statistics Austria, Guglgasse 13, A-1110 Vienna, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Hackl
authors.affiliation: Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria. Electronic address: klemens.rappersberger@wienkav.at.
authors.forename: Klemens
authors.initials: K
authors.lastname: Rappersberger
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000069342:Medical Overuse; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D013997:Time Factors; D055815:Young Adult
keywords: Cancer registry; Epidemiology; Incidence rate; Melanoma; Overdiagnosis; Underreporting