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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.

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    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
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