Recent statistics cohort analysis of mortality reveals that skin melanoma rates are dropping in the younger cohorts. Therefore, the aim of this study is to provide up-to-date information and to analyze recent changes in skin melanoma mortality trends in Spain during the period of 1975-2004 using joinpoint regression and age-period-cohort models. Between 1975 and, the age-standardized (overall) mortality rates for skin melanoma increased from 0.3 to 1.3 per 100,000 person-years for males and from 0.2 to 0.8 per 100,000 person-years for females, with an estimated annual percentage of change of 4.8 and 4.3%, respectively. In men and women, the best fit was found for the full model, which simultaneously considered the effects of age, period and cohort. The risks among both males and females increased in each successive birth cohort born between 1895 and 1950. Thereafter, the risks declined through the most recent birth cohort born in 1970. Examination of the mortality trends by age group and birth cohort revealed that the recent less rapidly rising (men) or stabilizing (women) age-adjusted skin melanoma mortality rates in Spain were a result of declining mortality in the younger age groups and more recent birth cohorts. The particularly favorable trends in young people suggest that a further decline in mortality from skin melanoma in Spain is likely to occur within the next few years. ' 2007 Wiley-Liss, Inc.Key words: age-period-cohort models; skin melanoma; mortality; trends; epidemiology In Europe, 26,100 males and 33,300 females are diagnosed each year with melanoma, and around 8,300 males and 7,600 females die because of it. It is the 8th most commonly diagnosed cancer in females and 17th in males.
1In Northern Europe, where incidence rates are high, mortality rates seem to be leveling off since the mid-1990's, especially in younger age groups. In contrast, in Southern and Eastern Europe rates are increasing steeply in all age categories.
2,3Spain has one of Europe's lowest melanoma incidence and mortality rates. 4 In a previous report, 5 we analyzed skin melanoma mortality trends in Spain during the period , showing that mortality rates increased in the last few decades, although this rising trends are now leveling off in middle-aged adults (35-64 years), following a similar tendency to that observed in other countries. 3,6 Skin melanoma mortality trends can be attributed to changes due to methods of classifying cause of death, short-term effects of early detection and the effects of new medical procedures, which can reduce melanoma mortality near the time of death (period effects), and changes that are associated with the generation to which people belong (cohort effects).7 In many countries a socalled age-cohort pattern was observed in both sexes. This means that starting with some specific birth cohort the mortality is increasing or decreasing for successive cohorts rather than for successive time periods. 2,8 Therefore, the aim of this study is to provide up-to-date information and to analyze recent changes...