Cutaneous malignant melanoma mortality in Spain from 1979 to 2018. Trends and new perspectives in the immunotherapy era

Abstract

Background Recent studies suggest that cutaneous melanoma mortality rates in Spain are stabilizing and even decreasing in younger cohorts. Objectives To analyse mortality rates of melanoma from the last 40 years, focusing on changes related with the development of new therapeutic approaches. Methods Death records and mid‐year population data were collected from the National Statistics Institute. By using the direct method, age‐standardized mortality rates were calculated for overall population and for each sex and age group. Significant changes in mortality trends were identified by Joinpoint regressions. The independent effects of age, period and cohort (APC) and potential years of life lost (PYLL) due to melanoma were also analysed. Results Age‐standardized melanoma mortality rates rose in Spain from 0.78 to 2.13 deaths per 100 000 from the first to the last quinquennium of the study (1979–1983 to 2014–2018) for the overall population. After a marked increase until 1995, mortality rates levelled off. Following this stabilization, from 2015 to 2018 there was a decrease in mortality rates for the overall population (average annual per cent change (AAPC): −4.3, not significant), more accused in males over 64 years old (yo). A period effect was observed from the beginning of 21st century, with mortality rates dropping to date. Conclusions There is a decrease in melanoma mortality rates from 2015 in all age groups that confirms previous trends in mortality in younger cohorts. Improvement in diagnosis and development of new therapies for advanced melanoma may have a crucial role in this event. Close monitoring of melanoma mortality rates is necessary to confirm these trends.

Cutaneous malignant melanoma mortality in Andalusia from 1979 to 2018. Toward new perspectives?

“…Recently, Durán‐Romero et al have carried out a study using the same methodology and also using the European standard population of 2013. We have observed lower figures compared to their findings 17 . Andalusia has some peculiarities, such as the significant insolation received or the relevant amount of people working on the primary sector of the economy, where workers are exposed to high rates of sun radiation in activities such as agriculture or fishing 29,30 .…”

“…Although it is necessary to determine the exact cause of this fact, we can hypothesize that the rise in sun exposure for recreational purposes together with the lower awareness regarding photoprotection in these cohorts could have influenced a more aggressive photoexposure. We must highlight the differences with the study of Durán‐Romero et al, 17 where this cohort effect is much more remarkable. We suggest that these differences account for the perpetuation in Andalusia of some of the factors that affect incidence or greater late diagnosis.…”

“…Inn older age groups mortality had been reported to be still rising 4 ; however, recent studies have shown a decrease even in this subgroup. 17 The north to south disparity in Europe in terms of figures related to melanoma is a well-known fact, with higher incidence rates at higher latitudes but without reducing the incidence/mortality ratio. 18 Although in our country we do not have national cancer registries, an increase in incidence has been observed in some partial provincial registries.…”

“…We have observed lower figures compared to their findings. 17 Andalusia has some peculiarities, such as the significant insolation received or the relevant amount of people working on the primary sector of the economy, where workers are exposed to high rates of sun radiation in activities such as agriculture or fishing. 29,30 Although these are known risk factors for the development of melanoma, 2 which could lead to a higher incidence, we hypothesized some factor that could explain this lower mortality rates: population accustomed to working outdoors could have a greater awareness of the risks of sun exposure, continuous sun exposure instead of intermittent burns as a protective factor.…”

Efecto del confinamiento por la pandemia de COVID-19 en el diagnóstico y el tratamiento del cáncer de piel

“…Se han intentado resumir los hechos y actitudes más relevantes en el manejo con respecto al cáncer de piel durante la pandemia que aún vivimos. Queda la gran duda para los próximos meses o años sobre qué va a ocurrir con ese 40% de los pacientes que se han dejado de atender y sobre todo qué ocurrirá con la mortalidad del cáncer de piel tanto de melanoma como no melanoma ahora que parecía que la tendencia comenzaba a descender, según los últimos estudios epidemiológicos 20 .…”