Cancer Trends No 7. Melanoma of skin
January 2011
Cancer
Trends
Melanoma of skin
Primary sites of melanoma
90% of invasive melanoma arises in the skin, 5% in the eye
ag‐specific incidence rate per 100,000 per year
Figure 2. Invasive melanoma by age, sex and period of
diagnosis 1994-2009
a. female
90
80
70
60
50
40
30
20
10
0
0‐34
35‐49
50‐64
and the remainder in a variety of sites including vulva (0.5%)
1994‐1998
nasal cavity (0.4%) and anus (0.2%). 2.4% of the melanomas
primary melanoma of the skin (invasive and in situ).
Time trends
In 2008 there were 443 invasive and 226 in situ
melanomas in women and 372 invasive and 159 in situ
ag‐specific incidence rate per 100,000 per year
situ melanomas are in the skin. This report describes only
1999‐2003
100
80
60
40
20
0
0‐34
35‐49
1994‐1998
incidence rates are also increasing: by 4.5% annually for
invasive melanoma in men and 2.0% in women and by 7.3%
and 4.6 % respectively for in situ lesions (Figure 1).
25
20
15
80+
1999‐2003
2004‐2009
40
35
30
25
20
15
10
5
0
0‐34
35‐49
50‐64
65‐79
80+
age at incidence
10
1994‐1998
5
1999‐2003
2004‐2009
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
year of incidence
male invasive
female invasive
male in situ
female in situ
Age profile
The age-specific incidence rate for both invasive and in situ
melanoma increased with age for both sexes (Figures 2 and
3) and also with time. Between 1994-1998 and 2004-2009,
ag‐specific incidence rate per 100,000 per year
b. male
0
1994
age‐standardised incidence rate, per 100,000 per year
Figure 1. Melanoma of skin: age-standardised incidence rate
1994-2009
65‐79
Figure 3. In situ melanoma by age, sex and period of
diagnosis 1994-2009
a. female
ag‐specific incidence rate per 100,000 per year
by 9.1% for males and 6.5% for females. Age-standardised
50‐64
age at incidence
are increasing in number—invasive melanoma by 5.8%
1 2004‐2009
120
melanomas in men. Both invasive and in situ melanomas
annually for males and 3.8% for females; in situ melanoma
80+
b. male
are diagnosed as of “unknown primary site” but most are
likely to have been cutaneous in origin. Almost all (99.5%) in
65‐79
age at incidence
40
35
30
25
20
15
10
5
0
increases in both invasive and in situ melanoma occurred
0‐34
35‐49
50‐64
65‐79
80+
age at incidence
1994‐1998
1999‐2003
2004‐2009
for almost all age groups. The largest increases were in the
older age groups in both sexes, particularly for men,
although there was a 44% increase (although from a low
base) in the incidence of invasive melanoma for women
under 35.
More information on cancer is available on our website www.ncri.ie
© National Cancer Registry 2011.
Cancer Trends No 7. Melanoma of skin
January 2011
Geographical variation
Within Europe, invasive melanoma incidence, for both men
and women, is highest in Scandinavia and lowest in south-
Figure 6. Melanoma thickness 1994-2008*, by period
number of cases
eastern Europe (Figure 4).1 The incidence for women in
0
500
1000
1500
2000
Ireland is one of the highest in Europe (4th highest of the 26
in situ (Tis)
is lower in relative terms (8th of 26) but still above the
<=0.75 mm (T1)
melanoma depth
countries shown here). The incidence rate for men in Ireland
European average.
Figure 4. Estimated melanoma incidence, 2008 (agestandardised rate)1
>1.5 mm and <=4.0 mm (T3)
>4.0 mm (T4)
Denmark
Norway
Sweden
Ireland
Czech Republic
United Kingdom
Iceland
Finland
Italy
Slovakia
Hungary
Croatia
Estonia
Lithuania
Bosnia Herzegovena
Latvia
Poland
Ukraine
Belarus
Russian Federation
Bulgaria
Cyprus
Republic of Moldova
Romania
Greece
Albania
unknown/not applicable
1994‐1998
1999‐2003
2004‐2008 Treatment
Overall, 90% of patients diagnosed with invasive melanoma in
2004-2008* had definitive surgery. This percentage fell with
age, from 97% for those under 30, to 89% for those over 80
(Figure 7). Women were slightly more likely than men to have
surgery (93% v 92%). Only 7% of patients with invasive
melanoma had chemotherapy in 2004-2008; 8% had
radiotherapy.
88% of in situ melanomas diagnosed in 2004-2008 were
15
10
5
0
5
10
15
20
age‐standardised incidence rate per 100,000 (world standard population)
female
male
recorded as having surgery. However, some in situ
melanomas not recorded as having surgery may have been
completely excised at biopsy. 97% of in situ melanomas had
Melanoma thickness
either surgery or biopsy.
Figure 7. Patients having surgery for invasive melanoma
2004-2008*, by age & sex
<=0.75mm and 22% between 0.75mm and 1.5mm. Thinner
100%
lesions were more common in women, while thicker (T4, >4
95%
% having surgery
mm) were commoner in men (Figure 5). Uptake of screening
and/or better awareness may be responsible for some of
this difference between sexes. The number of cases of in
90%
85%
situ melanomas increased by 138% and thin lesions (T1;
<=0.75 mm) by 161% between 1994-1998 and 200475% over the same period (Figure 6).
80+
<30
80%
2008*, while lesions thicker than 0.75 mm increased by
70‐79
factor for melanoma. 23% of invasive melanomas were
60‐69
Thickness, or depth of invasion, is an important prognostic
50‐59
20
40‐49
25
30‐39
2 >0.75 mm and <=1.5 mm (T2)
age at incidence
female
male
Figure 5. Melanoma thickness 1994-2008*, by sex
number of cases
0
200
400
600
800
1000 1200

Data on tumour size, thickness and treatment for 2009 was
incomplete and is excluded
in situ (Tis)
melanoma depth
<=0.75 mm (T1)
>0.75 mm and <=1.5 mm (T2)
>1.5 mm and <=4.0 mm (T3)
>4.0 mm (T4)
unknown/not applicable
male
female
More information on cancer is available on our website www.ncri.ie
© National Cancer Registry 2011.
Cancer Trends No 7. Melanoma of skin
January 2011
Survival
Mortality
Overall survival for cases of invasive melanoma diagnosed in
Deaths from malignant melanoma increased from 16 a year
1994-2008 was 88% (95% confidence interval 87%-89%)
in 1955-1960 to 113 a year in 2004-2007.3 Some of the
for women five years after diagnosis, and 79% (77%-81%)
increase in earlier years is almost certainly due to improving
for men. There was no significant change in survival over this
quality of diagnosis and certification, but the continuing
period. Age, sex, tumour thickness and having surgery were
increase in male mortality rates since the 1990s, in contrast
all independent prognostic factors; the hazard ratio for men
with the relatively small increase for women (Figure 10), is a
was 61% greater than for women when all other factors were
cause for concern.
allowed for (Figure 8). Melanoma survival in Ireland was
Figure 10. Age-standardised mortality rate for melanoma
1995-2007: five-year moving average3
although poorer than in Northern Ireland, especially for men
(Figure 9).2
Figure 8. Survival: multivariate hazard ratios for main
prognostic factors 1994-2008 (adjusted for year of diagnosis)
hazard ratio
0
2
4
6
8
10
12
14
16
<35
2.5
age‐standardised mortality rate per 100,000 (world standard population)
close to the European average for both men and women,
2.0
1.5
male rate
1.0
female rate
0.5
age
2005
2000
1995
1990
1985
1980
1975
1970
65‐79
Melanoma mortality for women in Ireland in 2001-2005 was
80+
11th highest of the 29 European countries shown in Figure
<=0.75 mm (T1)
11, while male mortality was 20th.3 Male mortality was higher
than
>0.75 mm and <=1.5 mm (T2)
thickness
1965
1955
year of death
50‐64
female
in
all
countries
shown,
although
the
>1.5 mm and <=4.0 mm (T3)
male/female ratio in Ireland was one of the lowest. The
>4.0 mm (T4)
much lower mortality and better survival for melanoma in
Northern Ireland compared to Ireland is striking.
unknown/not applicable
Figure 11. Melanoma mortality, 2001-2005 (agestandardised rate)3
sex
female
male
yes
surgery
3 1960
0.0
35‐49
no
Figure 9. Five-year relative survival for cases diagnosed
1995-19992
UK Northern Ireland
Sweden
Switzerland
UK Scotland
Netherlands
Iceland
Norway
Germany
Denmark
France
Finland
Italy
UK England
Malta
Ireland
Spain
Austria
Slovenia
Portugal
Belgium
Czech Republic
UK Wales
Slovakia
Poland
EUROCARE average
Norway
Slovenia
Denmark
Croatia
Sweden
The Netherlands
Slovakia
Czech Republic
Hungary
Austria
Luxembourg
Estonia
Switzerland
Finland
Lithuania
UK, England and Wales
Poland
Ireland
UK, Scotland
Iceland
Latvia
UK, Northern Ireland
Serbia
Germany
France
Romania
Bulgaria
Spain
Greece
3
2
1
0
1
2
3
4
5
age‐standardised mortality rate per 100,000 (world standard population)
female
100
80
60
40
20
0
20
40
five‐year relative survival female
60
80
100
male
1. European Cancer Observatory (ECO) www-dep.iarc.fr
2. EUROCARE 4 www.eurocare.it
3. WHO Mortality Database www-dep.iarc.fr
male
More information on cancer is available on our website www.ncri.ie
© National Cancer Registry 2011.