Changes in the annual lifetime risk of developing invasive melanoma in the United States from 1930 to 2016.
Estimated number of annual deaths from melanoma in the United States from 2009 to present.
Glazer AM, Winkelmann RR, Farberg AS, Rigel DS. Analysis of Trends in US Melanoma Incidence and Mortality. JAMA Dermatol. Published online December 21, 2016. doi:10.1001/jamadermatol.2016.4512
The incidence of and mortality from invasive melanoma in the United States has risen steadily for at least the past 2 decades.1 Similar trends are being seen worldwide despite numerous efforts to enhance primary prevention and early detection, and these increasing rates are having an impact on the public health and economic burden of disease. In 2009, we reported on the status of US melanoma incidence at that time.2 The purpose of this study was to provide updated information on trends in melanoma incidence and mortality that will help to elucidate the current state of this cancer in the United States.
The absolute number of invasive melanomas reported in 2016 were obtained for comparison with similarly obtained data in 2009.1,3 Calculations were made to determine the lifetime risk of developing a melanoma based on estimated annual incidence, average life expectancy, and the base years’ US population after correcting for persons with multiple primary melanomas. Raw incidence rates were calculated for 2016 and compared with 2009 to determine the cumulative increase. Compound annual growth rates (CAGR) were then calculated to determine the annual percentage growth rate over the 7-year study interval. Institutional review board approval was not applicable because this study did not report on data involving human subjects.
An estimated 76 380 Americans will be diagnosed with invasive melanoma in 2016.1 Melanoma raw incidence rates per 100 000 population also climbed from 22.2 to 23.6 (0.9% CAGR). The current lifetime risk of an American developing invasive melanoma is 1 in 54 compared with 1 in 58 when we last reported in 2009 (Figure 1).2 In situ melanoma incidence has risen more rapidly over the studied period (3.0% CAGR) with the lifetime risk of developing in situ melanoma rising from 1 in 78 to 1 in 58 during the studied period. In combination with the estimated 68 480 cases of in situ melanoma in 2016, the lifetime risk for being diagnosed with invasive or in situ melanoma is now 1 in 28. The annual number of population-adjusted melanoma deaths has risen at a 1.5% CAGR (raw mortality rates per 100 000 population increasing from 2.8 to 3.1) with a current estimate that 10 130 Americans will die from melanoma in 2016 (up from 8650 in 2009) (Figure 2).
The overall burden of disease for melanoma is increasing and rising rates are not simply artifact owing to increased detection of indolent disease.2 Actual incidence rates may be higher than noted in this study because melanoma is not a reportable disease in many states and some tumors that are biopsied and excised in an outpatient setting may miss hospital tumor registries if they are processed in nonhospital pathology laboratories. The incidence of melanoma in situ is increasing at a faster rate than that of invasive melanoma and the incidence of thin invasive tumors are also increasing at a faster rate than thicker tumors. Nevertheless, the absolute number of thicker tumors is still materially increasing which is having an impact on the mortality rate.4 Five-year survival rates are also rising, likely owing to the increasing ratio of thin to thicker tumors, and this will hopefully continue to improve.
Other studies have proposed that invasive melanoma incidence rates are rising more rapidly than mortality, suggesting that earlier detection is having an impact.5 However, despite the 2014 Surgeon General’s Call to Action to Prevent Skin Cancer,6 this study’s results demonstrate that the incidence of invasive melanoma in the United States is increasing on a lesser trajectory in the last 7 years than the mortality rate, suggesting that we may not yet be seeing the effect of earlier detection on melanoma mortality.
Corresponding Author: Alex M. Glazer, MD, National Society for Cutaneous Medicine, 35 E 35th St No. 208 New York, NY 10016 (firstname.lastname@example.org).
Accepted for Publication: September 29, 2016.
Published Online: December 21, 2016. doi:10.1001/jamadermatol.2016.4512
Author Contributions: Drs Glazer and Rigel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Glazer, Farberg, Rigel.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Glazer, Farberg, Rigel.
Administrative, technical, or material support: Glazer, Farberg.
Conflict of Interest Disclosures: None reported.