Age-Specific Incidence of Melanoma in the United States | Adolescent Medicine | JAMA Dermatology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.236.187.155. Please contact the publisher to request reinstatement.
1.
Siegel  RL, Miller  KD, Jemal  A.  Cancer statistics, 2017.  CA Cancer J Clin. 2017;67(1):7-30. doi:10.3322/caac.21387PubMedGoogle ScholarCrossref
2.
National Cancer Institute. Noone  AM, Howlader  N, Krapcho  M,  et al. SEER cancer statistics review (CSR) 1975-2015. https://seer.cancer.gov/csr/1975_2015/. Updated September 10, 2018. Accessed March 1, 2019.
3.
Long  GV, Hauschild  A, Santinami  M,  et al.  Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma.  N Engl J Med. 2017;377(19):1813-1823. doi:10.1056/NEJMoa1708539PubMedGoogle ScholarCrossref
4.
Weber  J, Mandala  M, Del Vecchio  M,  et al; CheckMate 238 Collaborators.  Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma.  N Engl J Med. 2017;377(19):1824-1835. doi:10.1056/NEJMoa1709030PubMedGoogle ScholarCrossref
5.
D’Angelo  SP, Larkin  J, Sosman  JA,  et al.  Efficacy and safety of nivolumab alone or in combination with ipilimumab in patients with mucosal melanoma: a pooled analysis.  J Clin Oncol. 2017;35(2):226-235. doi:10.1200/JCO.2016.67.9258PubMedGoogle ScholarCrossref
6.
Ribas  A, Puzanov  I, Dummer  R,  et al.  Pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory melanoma (KEYNOTE-002): a randomised, controlled, phase 2 trial.  Lancet Oncol. 2015;16(8):908-918. doi:10.1016/S1470-2045(15)00083-2PubMedGoogle ScholarCrossref
7.
Robert  C, Ribas  A, Wolchok  JD,  et al.  Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial.  Lancet. 2014;384(9948):1109-1117. doi:10.1016/S0140-6736(14)60958-2PubMedGoogle ScholarCrossref
8.
Robert  C, Schachter  J, Long  GV,  et al; KEYNOTE-006 Investigators.  Pembrolizumab versus ipilimumab in advanced melanoma.  N Engl J Med. 2015;372(26):2521-2532. doi:10.1056/NEJMoa1503093PubMedGoogle ScholarCrossref
9.
Wolchok  JD, Rollin  L, Larkin  J.  Nivolumab and ipilimumab in advanced melanoma.  N Engl J Med. 2017;377(25):2503-2504. doi:10.1056/NEJMc1714339PubMedGoogle ScholarCrossref
10.
Wolchok  JD, Weber  JS, Hamid  O,  et al.  Ipilimumab efficacy and safety in patients with advanced melanoma: a retrospective analysis of HLA subtype from four trials.  Cancer Immun. 2010;10:9.PubMedGoogle Scholar
11.
Dummer  R, Ascierto  PA, Gogas  HJ,  et al.  Encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF-mutant melanoma (COLUMBUS): a multicentre, open-label, randomised phase 3 trial.  Lancet Oncol. 2018;19(5):603-615. doi:10.1016/S1470-2045(18)30142-6PubMedGoogle ScholarCrossref
12.
Menzies  AM, Long  GV.  Dabrafenib and trametinib, alone and in combination for BRAF-mutant metastatic melanoma.  Clin Cancer Res. 2014;20(8):2035-2043. doi:10.1158/1078-0432.CCR-13-2054PubMedGoogle ScholarCrossref
13.
Gilchrest  BA, Eller  MS, Geller  AC, Yaar  M.  The pathogenesis of melanoma induced by ultraviolet radiation.  N Engl J Med. 1999;340(17):1341-1348. doi:10.1056/NEJM199904293401707PubMedGoogle ScholarCrossref
14.
Ferrucci  LM, Vogel  RI, Cartmel  B, Lazovich  D, Mayne  ST.  Indoor tanning in businesses and homes and risk of melanoma and nonmelanoma skin cancer in 2 US case-control studies.  J Am Acad Dermatol. 2014;71(5):882-887. doi:10.1016/j.jaad.2014.06.046PubMedGoogle ScholarCrossref
15.
Dennis  LK, Vanbeek  MJ, Beane Freeman  LE, Smith  BJ, Dawson  DV, Coughlin  JA.  Sunburns and risk of cutaneous melanoma: does age matter? a comprehensive meta-analysis.  Ann Epidemiol. 2008;18(8):614-627. doi:10.1016/j.annepidem.2008.04.006PubMedGoogle ScholarCrossref
16.
Qureshi  AA, Zhang  M, Han  J.  Heterogeneity in host risk factors for incident melanoma and non-melanoma skin cancer in a cohort of US women.  J Epidemiol. 2011;21(3):197-203. doi:10.2188/jea.JE20100145PubMedGoogle ScholarCrossref
17.
Green  AC, Williams  GM, Logan  V, Strutton  GM.  Reduced melanoma after regular sunscreen use: randomized trial follow-up.  J Clin Oncol. 2011;29(3):257-263. doi:10.1200/JCO.2010.28.7078PubMedGoogle ScholarCrossref
18.
Watts  CG, Drummond  M, Goumas  C,  et al.  Sunscreen use and melanoma risk among young Australian adults.  JAMA Dermatol. 2018;154(9):1001-1009. doi:10.1001/jamadermatol.2018.1774PubMedGoogle ScholarCrossref
19.
Cokkinides  V, Weinstock  M, Glanz  K, Albano  J, Ward  E, Thun  M.  Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among US adolescents, 1998-2004.  Pediatrics. 2006;118(3):853-864. doi:10.1542/peds.2005-3109PubMedGoogle ScholarCrossref
20.
Centers for Disease Control and Prevention.  Melanoma Incidence and Mortality, United States—2012–2016. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2019.
21.
Centers for Disease Control and Prevention. 2001–2015 database: National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence—US Cancer Statistics Public Use Research Database, November 2017 submission (2001–2015), United States Dept of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Created on 4/27/2018. https://www.cdc.gov/cancer/uscs/public-use. Published April 27, 2018. Accessed March 1, 2019.
22.
Surveillance Research Program, National Cancer Institute. SEER*Stat software. https://seer.cancer.gov/seerstat. Accessed March 1, 2019.
23.
Tiwari  RC, Clegg  LX, Zou  Z.  Efficient interval estimation for age-adjusted cancer rates.  Stat Methods Med Res. 2006;15(6):547-569. doi:10.1177/0962280206070621PubMedGoogle ScholarCrossref
24.
Neter  J, Wasserman  W, Kutner  M. Applied Linear Statistical Models. 2nd ed. New York, NY: Mc-Graw-Hill Higher Education; 1985.
25.
Kim  HJ, Fay  MP, Feuer  EJ, Midthune  DN.  Permutation tests for joinpoint regression with applications to cancer rates.  Stat Med. 2000;19(3):335-351. doi:10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-ZPubMedGoogle ScholarCrossref
26.
Introduction to SEER*Stat. https://seer.cancer.gov/seerstat/WebHelp/seerstat.htm. Accessed August 1, 2019.
27.
Albertini  MR.  The age of enlightenment in melanoma immunotherapy.  J Immunother Cancer. 2018;6(1):80. doi:10.1186/s40425-018-0397-8PubMedGoogle ScholarCrossref
28.
Holman  DM, Ding  H, Guy  GP  Jr, Watson  M, Hartman  AM, Perna  FM.  Prevalence of sun protection use and sunburn and association of demographic and behaviorial characteristics with sunburn among US adults.  JAMA Dermatol. 2018;154(5):561-568. doi:10.1001/jamadermatol.2018.0028PubMedGoogle ScholarCrossref
29.
Gefeller  O.  The garment protection factor: further advances in labelling sun-protective clothing.  Br J Dermatol. 2018;178(4):835-836. doi:10.1111/bjd.16344PubMedGoogle ScholarCrossref
30.
Iannacone  MR, Youlden  DR, Baade  PD, Aitken  JF, Green  AC.  Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia.  Int J Cancer. 2015;136(3):603-609. doi:10.1002/ijc.28956PubMedGoogle Scholar
31.
Strouse  JJ, Fears  TR, Tucker  MA, Wayne  AS.  Pediatric melanoma: risk factor and survival analysis of the Surveillance, Epidemiology and End Results database.  J Clin Oncol. 2005;23(21):4735-4741. doi:10.1200/JCO.2005.02.899PubMedGoogle ScholarCrossref
32.
Wong  JR, Harris  JK, Rodriguez-Galindo  C, Johnson  KJ.  Incidence of childhood and adolescent melanoma in the United States: 1973-2009.  Pediatrics. 2013;131(5):846-854. doi:10.1542/peds.2012-2520PubMedGoogle ScholarCrossref
33.
Campbell  LB, Kreicher  KL, Gittleman  HR, Strodtbeck  K, Barnholtz-Sloan  J, Bordeaux  JS.  Melanoma incidence in children and adolescents: decreasing trends in the United States.  J Pediatr. 2015;166(6):1505-1513. doi:10.1016/j.jpeds.2015.02.050PubMedGoogle ScholarCrossref
34.
Aoude  LG, Wadt  KA, Pritchard  AL, Hayward  NK.  Genetics of familial melanoma: 20 years after CDKN2A.  Pigment Cell Melanoma Res. 2015;28(2):148-160. doi:10.1111/pcmr.12333PubMedGoogle ScholarCrossref
35.
Cordoro  KM, Gupta  D, Frieden  IJ, McCalmont  T, Kashani-Sabet  M.  Pediatric melanoma: results of a large cohort study and proposal for modified ABCD detection criteria for children.  J Am Acad Dermatol. 2013;68(6):913-925. doi:10.1016/j.jaad.2012.12.953PubMedGoogle ScholarCrossref
36.
Gershenwald  JE, Guy  GP  Jr.  Stemming the rising incidence of melanoma: calling prevention to action.  J Natl Cancer Inst. 2015;108(1):pii:djv381. doi:10.1093/jnci/djv381PubMedGoogle Scholar
37.
Lazovich  D, Isaksson Vogel  R, Weinstock  MA, Nelson  HH, Ahmed  RL, Berwick  M.  Association between indoor tanning and melanoma in younger men and women.  JAMA Dermatol. 2016;152(3):268-275. doi:10.1001/jamadermatol.2015.2938PubMedGoogle ScholarCrossref
38.
Wu  S, Han  J, Laden  F, Qureshi  AA.  Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study.  Cancer Epidemiol Biomarkers Prev. 2014;23(6):1080-1089. doi:10.1158/1055-9965.EPI-13-0821PubMedGoogle ScholarCrossref
39.
Lu  C, Zhang  J, Nagahawatte  P,  et al.  The genomic landscape of childhood and adolescent melanoma.  J Invest Dermatol. 2015;135(3):816-823. doi:10.1038/jid.2014.425PubMedGoogle ScholarCrossref
40.
Wojcik  KY, Escobedo  LA, Wysong  A,  et al.  High birth weight, early UV exposure, and melanoma risk in children, adolescents, and young adults.  Epidemiology. 2019;30(2):278-284. doi:10.1097/EDE.0000000000000963PubMedGoogle ScholarCrossref
41.
Siegel  RL, Miller  KD, Jemal  A.  Cancer statistics, 2019.  CA Cancer J Clin. 2019;69(1):7-34. doi:10.3322/caac.21551PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    EXPAND ALL
    RE: Age-specific incidence of melanoma in the United States
    Tomoyuki Kawada, MD | Nippon Medical School
    Paulson et al. examine the incidence of invasive melanoma in the United States with special reference to aging (1). In adults, aged 40 years or older, incidence increased by an annual percentage change (APC) of 1.8% in both men and women. In contrast, incidence decreased by APC of -4.4% for male adolescents, -5.4% for female adolescents, -3.7% for male young adults, and -3.6% for female young adults, respectively. The authors confirmed that incidence of melanoma decreased in adolescents and young adults, and incidence of melanoma increased in older populations. I have two concerns about their study.

    First, Bray et
    al. assessed 20-year change in incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (2). The incidence of head and neck melanoma increased 51.1% from 1995 to 2014. In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. They specified that male sex, older age, and non-Hispanic white race/ethnicity presented an increased incidence of head and neck melanoma. I suppose that inconsistent results between two reports might partly be related to statistical procedure and ranges of age in the target population. In addition, body region of melanoma might be closely related to incidence.

    Second, Thrift and Gudenkauf also examined the change in melanoma incidence among non-Hispanic whites in the United States from 2001 to 2015 by using APC (3). Melanoma incidence increased by 3.90% annually between 2001 and 2005, and 1.68% annually from 2005 through 2015. APC in incidence were 2.34% in men and 2.25% in women. Age-specific relative risk by birth cohort increased from 1921 until 1981. But incidence in adults born in 1991 decreased 15%, compared with adults born in 1956. They also pointed out that geographic variation existed for the incidence. Ethnicity, race and place of residence should also be considered for incidence of melanoma, in combination with aging and body region.


    REFERENCES

    1. Paulson KG, Gupta D, Kim TS, et al. Age-specific incidence of melanoma in the United States. JAMA Dermatol 2019 Nov 13. doi: 10.1001/jamadermatol.2019.3353

    2. Bray HN, Simpson MC, Zahirsha ZS, et al. Head and neck melanoma incidence trends in the pediatric, adolescent, and young adult population of the United States and Canada, 1995-2014. JAMA Otolaryngol Head Neck Surg 2019 Oct 3. doi: 10.1001/jamaoto.2019.2769

    3. Thrift AP, Gudenkauf FJ. Melanoma incidence among non-Hispanic whites in all 50 United States from 2001 through 2015. J Natl Cancer Inst 2019 Jul 25. pii: djz153. doi: 10.1093/jnci/djz153
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    November 13, 2019

    Age-Specific Incidence of Melanoma in the United States

    Author Affiliations
    • 1Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
    • 2Division of Medical Oncology, University of Washington, Seattle
    • 3Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington
    • 4Seattle Children’s Hospital, Seattle, Washington
    • 5Division of Dermatology, University of Washington, Seattle
    • 6Department of Pediatrics, University of Washington, Seattle
    • 7Department of Surgery, University of Washington, Seattle
    • 8Department of Epidemiology, University of Washington School of Public Health, Seattle
    • 9Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
    JAMA Dermatol. 2020;156(1):57-64. doi:10.1001/jamadermatol.2019.3353
    Key Points

    Question  Is the incidence of melanoma in the United States changing between age groups?

    Findings  In this population-based study including 988 103 cases of invasive melanoma reported between 2001 and 2015, the melanoma incidence increased overall but decreased among individuals aged 10 to 29 years at diagnosis in the United States from 2006 to 2015. These findings were based on data from the US Cancer Statistics National Program of Cancer Registries.

    Meaning  The apparent decline in the incidence of melanoma in adolescents and young adults in the United States contrasts with increased incidence in melanoma in older ages and is possibly associated with sun protective interventions, providing support for ongoing prevention efforts.

    Abstract

    Importance  Melanoma is epidemiologically linked to UV exposure, particularly childhood sunburn. Public health campaigns are increasing sun-protective behavior in the United States, but the effect on melanoma incidence is unknown.

    Objective  To examine the incidence of melanoma in the United States and whether any age-specific differences are present.

    Design, Setting, and Participants  Observational, population-based registry data were extracted on July 3, 2018, from the combined National Program of Cancer Registries–Surveillance Epidemiology and End Results United States Cancer Statistics database for 2001-2015. Deidentified data for 988 103 cases of invasive melanoma, with International Classification of Diseases for Oncology histologic categorization codes 8720 to 8790, were used for analysis. Data analysis was performed from July 1, 2018, to March 1, 2019.

    Main Outcomes and Measures  The annual rates of melanoma in pediatric, adolescent, young adult, and adult age groups were determined. Analyses were stratified by sex, and incidence rates were age-adjusted to the 2000 US standard population. Annual percentage change (APC) in incidence rate was calculated over the most recent decade for which data were available (2006-2015) using the weighted least squares method.

    Results  In 2015, 83 362 cases of invasive melanoma were reported in the United States, including 67 in children younger than 10 years, 251 in adolescents (10-19 years), and 1973 in young adults (20-29 years). Between 2006 and 2015, the overall incidence rate increased from 200.1 to 229.1 cases per million person-years. In adults aged 40 years or older, melanoma rates increased by an APC of 1.8% in both men (95% CI, 1.4%-2.1%) and women (95% CI, 1.4%-2.2%). In contrast, clinically and statistically significant decreases were seen in melanoma incidence for adolescents and young adults. Specifically, incidence rates decreased by an APC of −4.4% for male adolescents (95% CI, −1.7% to −7.0%), −5.4% for female adolescents (95% CI, −3.3% to −7.4%), −3.7% for male young adults (95% CI, −2.5% to −4.8%), and −3.6% for female young adults (95% CI, −2.8% to −4.5%). Data on skin pigmentation and sun protection history were unavailable; similar trends were observed with data limited to non-Hispanic whites. Young adult women appeared to have twice the risk of melanoma as young adult men.

    Conclusions and Relevance  The incidence of invasive melanoma in the United States appeared to decrease in adolescents and young adults from 2006 to 2015, and this finding contrasted with increases in older populations. These incidence trends suggest that public health efforts may be favorably influencing melanoma incidence in the United States.

    ×