title: Tumour stage distribution and survival of malignant melanoma in Germany 2002-2011.
abstract: Over the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients.
  
  
  
  Pooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival.
  
  
  
  The number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97-0.97), sex (OR 1.18, 95% CI 1.11-1.25), date of diagnosis (OR 1.05, 95% CI 1.04-1.06), 'diagnosis during screening' (OR 3.24, 95% CI 2.50-4.19) and place of residence (OR 1.23, 95% CI 1.16-1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8-83.9%).
  
  
  
  No distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.
authors.affiliation: Cancer Epidemiology, University Cancer Center, Technische Universität Dresden, Dresden, Germany. olaf.schoffer@tum.de.|Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany. olaf.schoffer@tum.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Schoffer
authors.affiliation: Cancer Epidemiology, University Cancer Center, Technische Universität Dresden, Dresden, Germany.|Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schülein
authors.affiliation: Onkologischer Schwerpunkt (OSP) Göppingen, Göppingen, Germany.
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Arand
authors.affiliation: Tumour Centre Augsburg, Augsburg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Arnholdt
authors.affiliation: Tumour Centre Chemnitz, Chemnitz, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Baaske
authors.affiliation: Tumour Centre Würzburg, Würzburg, Germany.
authors.forename: Ralf C
authors.initials: RC
authors.lastname: Bargou
authors.affiliation: National Centre for Tumour Diseases (NCT) Heidelberg, Heidelberg, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.affiliation: Tumour Centre Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Onkologische Qualitätssicherung (QS) in Westfalen-Lippe, Münster, Germany.
authors.forename: Yves
authors.initials: Y
authors.lastname: Bodack
authors.affiliation: Regional Clinical Cancer Registry Magdeburg, Magdeburg, Germany.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Böhme
authors.affiliation: Tumour Centre Koblenz, Koblenz, Germany.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Bozkurt
authors.affiliation: Tumour Centre Vorpommern, Greifswald, Germany.
authors.forename: Regine
authors.initials: R
authors.lastname: Breitsprecher
authors.affiliation: Tumour Centre Brandenburg, Frankfurt (Oder), Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Buchali
authors.affiliation: Regional Clinical Cancer Registry Magdeburg, Magdeburg, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Burger
authors.affiliation: Tumour Centre Jena, Jena, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Burger
authors.affiliation: Tumour Centre Schwerin, Schwerin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Dommisch
authors.affiliation: Onkologischer Schwerpunkt (OSP) Göppingen, Göppingen, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Elsner
authors.affiliation: Suedharz Klinikum Nordhausen gGmbH, Nordhausen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Fernschild
authors.affiliation: Tumour Centre Neubrandenburg, Neubrandenburg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Flintzer
authors.affiliation: Tumour Centre Gera, Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Funke
authors.affiliation: Tumour Centre Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gerken
authors.affiliation: Tumour Centre Erfurt, Erfurt, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Göbel
authors.affiliation: Tumour Centre Neubrandenburg, Neubrandenburg, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Grobe
authors.affiliation: Tumour Centre Freiburg/Comprehensive Cancer Centre Freiburg (CCCF), Freiburg im Breisgau, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Gumpp
authors.affiliation: Tumour Centre Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Lucie
authors.initials: L
authors.lastname: Heinzerling
authors.affiliation: National Centre for Tumour Diseases (NCT) Heidelberg, Heidelberg, Germany.
authors.forename: Lana Raffaela
authors.initials: LR
authors.lastname: Kempfer
authors.affiliation: Tumour Centre Oberfranken, Bayreuth, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kiani
authors.affiliation: Tumour Centre Regensburg, Regensburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Klinkhammer-Schalke
authors.affiliation: Tumour Centre Rostock, Rostock, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Klöcking
authors.affiliation: Cancer Register of Southwest Saxony, Zwickau, Zwickau, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Kreibich
authors.affiliation: Suedharz Klinikum Nordhausen gGmbH, Nordhausen, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Knabner
authors.affiliation: Tumour Centre Ulm/Comprehensive Cancer Centre Ulm (CCCU), Ulm, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kuhn
authors.affiliation: Tumour Centre Vorpommern, Greifswald, Germany.
authors.forename: Stine
authors.initials: S
authors.lastname: Lutze
authors.affiliation: Tumour Centre Würzburg, Würzburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Mäder
authors.affiliation: Tumour Centre Oberfranken, Bayreuth, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Maisel
authors.affiliation: Tumour Centre Görlitz, Görlitz, Germany.|Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Maschke
authors.affiliation: Comprehensive Cancer Centre (CCC) Marburg, Marburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Middeke
authors.affiliation: Comprehensive Cancer Centre (CCC) Marburg, Marburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neubauer
authors.affiliation: Regional Clinical Cancer Registry Dresden, Dresden, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Niedostatek
authors.affiliation: Tumour Centre Schwerin, Schwerin, Germany.
authors.forename: Anabelle
authors.initials: A
authors.lastname: Opazo-Saez
authors.affiliation: Tumour Centre Freiburg/Comprehensive Cancer Centre Freiburg (CCCF), Freiburg im Breisgau, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Peters
authors.affiliation: Tumour Centre Gera, Gera, Germany.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Schell
authors.affiliation: Tumour Centre Augsburg, Augsburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schenkirsch
authors.affiliation: Tumour Centre Jena, Jena, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schmalenberg
authors.affiliation: Klinisches Krebsregister Halle, Halle, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schmidt
authors.affiliation: Tumour Centre Brandenburg, Frankfurt (Oder), Germany.
authors.forename: Constanze
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Tumour Centre Chemnitz, Chemnitz, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Schubotz
authors.affiliation: Tumour Centre Koblenz, Koblenz, Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Seide
authors.affiliation: Tumour Centre Erfurt, Erfurt, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Strecker
authors.affiliation: Tumour Centre Leipzig, Leipzig, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Taubenheim
authors.affiliation: Tumour Centre Suhl, Suhl, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wackes
authors.affiliation: Tumour Centre Görlitz, Görlitz, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Weiß
authors.affiliation: Tumour Centre Ulm/Comprehensive Cancer Centre Ulm (CCCU), Ulm, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Welke
authors.affiliation: Regional Clinical Cancer Registry Dresden, Dresden, Germany.
authors.forename: Carmen
authors.initials: C
authors.lastname: Werner
authors.affiliation: Tumour Centre Leipzig, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wittekind
authors.affiliation: Cancer Register of Southwest Saxony, Zwickau, Zwickau, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wulff
authors.affiliation: Tumour Centre Rostock, Rostock, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Zettl
authors.affiliation: Cancer Epidemiology, University Cancer Center, Technische Universität Dresden, Dresden, Germany.|Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany.
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Klug
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: Malignant melanoma; Skin cancer screening; Stage distribution; Survival analysis; TNM staging