Tumour stage distribution and survival of malignant melanoma in Germany 2002–2011

Abstract

BackgroundOver the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients.MethodsPooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival.ResultsThe number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97–0.97), sex (OR 1.18, 95% CI 1.11–1.25), date of diagnosis (OR 1.05, 95% CI 1.04–1.06), ‘diagnosis during screening’ (OR 3.24, 95% CI 2.50–4.19) and place of residence (OR 1.23, 95% CI 1.16–1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8–83.9%).ConclusionsNo distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2963-0) contains supplementary material, which is available to authorized users.

Evaluation of the agreement between TNM 7th and 8th in a population‐based series of cutaneous melanoma

“…Some of these differences go beyond the random fluctuation in our data set and may be related to the difference between a population‐based and a clinical series. In fact, our results are close to those documented by the North American Association of Central Cancer Registries and in a mainly population‐based German series …”

“…In fact, our results are close to those documented by the North American Association of Central Cancer Registries 14 and in a mainly population-based German series. 15 In conclusion, TNM8 has introduced several changes in SM staging. These modifications are aimed at improving the clinical management of patients.…”

Considering adjuvant therapy for stage II melanoma

“…This may be a modest underestimation of the true stage II incidence because SEER data do not contain staging data for approximately 9% of cases. European data sets suggest that a range from 10% to 20% of all new cases present as stage II, smaller fractions present with stage III or IV disease, and the majority of new cases present as stage I, similar to US data (Fig. ) …”

“…Data from the Surveillance, Epidemiology, and End Results (SEER) program database were estimated using the percentage frequency distribution by stage derived from SEER*Stat software; specifically, patients who had newly diagnosed with melanoma in years 2011 through 2015 were used, and stage group was derived from the American Joint Committee on Cancer, 7th edition, for all ages combined. Data sources include the National Cancer Institute, 2018; Rockberg et al, 2016; and Schoffer et al, 2016 …”

“…1). [5][6][7] The AJCC has modified the melanoma staging system over time to account for a better understanding of histologic prognostic factors. Many early adjuvant melanoma trials and epidemiologic data incorporate AJCC version 6 (AJCCv6), whereas more modern melanoma adjuvant trials have used AJCC version 7 (AJCCv7).…”