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Trends in cutaneous malignant melanoma in Sweden 1997-2011: Thinner tumours and improved survival among men
Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Department of Oncology-Pathology, Karolinska Institute, Stockholm.
Department of Oncology-Pathology, Karolinska Institute, Stockholm.
Department of Surgery, Lund University Hospital, Lund.
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2015 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 172, no 3, 700-706 p.Article in journal (Refereed) Published
Abstract [en]

Background: Both patient survival and the proportion of patients diagnosed with thin cutaneous malignant melanoma (CMM) have been steadily rising in Sweden as in most western countries, though the rate of improvement in survival appears to have declined in Sweden at the end of last millennium.

Objectives: To analyse the most recent trends in the distribution of tumour thickness (T-category) as well as CMM-specific survival in Swedish patients diagnosed 1997-2011.

Methods: This nationwide population-based study included 30 590 patients registered in the Swedish Melanoma Register (SMR) and diagnosed with a first primary invasive CMM 1997-2011. The patients were followed through 2012 in the national Cause-of-Death Register.

Results: Logistic and Cox regression analyses adjusting for age at diagnosis, tumour site, and health care region were carried out. The odds ratio for being diagnosed with thicker tumours was significantly reduced (P = 0·0008) and the CMM-specific survival significantly improved in men diagnosed 2007-2011 compared to men diagnosed 1997-2001 (hazard ratio=0·81; 95% CI 0·72-0·91, P = 0·0009) while the corresponding differences for women were not significant. Women were diagnosed with significantly thicker tumours during 2002-2006 and a tendency towards decreased survival was observed compared to those diagnosed earlier 1997-2001 and later 2007-2011.

Conclusion: In Sweden, the CMMs of men are detected earlier over time and this seems to be followed by an improved CMM-specific survival for men. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015. Vol. 172, no 3, 700-706 p.
Keyword [en]
malignant melanoma, time trend, survival, tumour thickness, population based
National Category
Dermatology and Venereal Diseases
URN: urn:nbn:se:liu:diva-113143DOI: 10.1111/bjd.13483ISI: 000351400500029PubMedID: 25323770OAI: diva2:779092
Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2016-04-01Bibliographically approved
In thesis
1. Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach
Open this publication in new window or tab >>Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM.

The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population.

For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs.

Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 51 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1428
Melanoma, early detection, population-based, registers, time trends, survival, prognostic factors, tumour thickness, stage at diagnosis, level of education, socioeconomic status, healthcare costs
National Category
Dermatology and Venereal Diseases Public Health, Global Health, Social Medicine and Epidemiology
urn:nbn:se:liu:diva-113145 (URN)10.3384/diss.diva-113145 (DOI)978-91-7519-191-1 (print) (ISBN)
Public defence
2015-02-13, Eken, ingång 65, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Available from: 2015-01-28 Created: 2015-01-12 Last updated: 2016-04-01Bibliographically approved

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Lyth, JohanCarstensen, John
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