Incidence and mortality of melanoma in situ and malignant melanoma in England between 2001 and 2020

Abstract

Background

Rising incidence of melanoma has been reported globally since the 20^th century, while melanoma mortality is no longer increasing in England and other countries. Improved therapeutics have reduced mortality. However, this phenomenon implicates “overdiagnosis”, where thinner melanomas of unclear malignant potential are being diagnosed possibly due to ‘diagnostic drift’.

Objectives

To assess the incidence and mortality trends for melanoma in situ (MIS) and malignant melanoma (MM) in England between 2001-2020 by age and gender.

Methods

Routinely collected data were analysed from the National Disease Registration Service for MIS and MM in England between 2001-2020. Joinpoint regression analysis calculated the trends and average annual percentage change (APC) in mortality, age-specific and age-standardised incidence by age and gender per 100,000 person years (PYs).

Results

Between 2001-2020, 86,792 MIS and 220,286 MM were recorded in England. Incidence (per 100,000 PYs) for MM increased most rapidly during 2001-06 from 14.6 to 19.6 (APC 6.29%), then to 26.7 during 2006-14 (APC 4.06%) and decelerated to 28.4 during 2014-19 (APC 1.35%). Incidence rates for MIS (per 100,000 PYs) decelerated over time from 4.5 to 12.5 in 2001-15 (APC 7.51%) and to 13.3 during 2015-19 (APC 1.90%). In those 0-24 years old, incidence of MM and MIS has been decreasing since the late 2000s, whereas MM incidence in those over 50 is mostly rising, with the greatest increases seen in those over 70. Mortality from MM remained higher in males, reduced in people under 60, and in adults 60-74 years old since the early 2010s. Mortality rates continued to increase in those over 75.

Conclusion

The deceleration of MM and MIS incidence rates may be due to stabilisation of any diagnostic drift, diversifying ethnicity and reduced sun seeking behaviours, particularly in younger generations. Mortality rates from MM have decreased since therapeutic developments in the early 2010s, and in younger generations before this. MM incidence and mortality are increasing most rapidly in males over 75 years old, the age-group with the highest incidence and expected growth in the future. These results support the importance of early melanoma detection, public health sun awareness campaigns, and better melanoma diagnostics.

Accepted manuscripts

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