Short Communication

A Prime minister managed to attract elderly men in a Belgian Euromelanoma campaign

It has been debated that the epidemic of melanoma is largely due to overdiagnosis, since increases in incidence were mainly among thin melanomas and mortality rates remained stable. Our objective was to examine this controversy in The Netherlands.

Information on newly diagnosed melanoma patients was obtained from The Netherlands Cancer Registry. European Standardized Rates and estimated annual percentage change were calculated for the period 1989–2008. Cohort-based, period-based and multivariate survival analyses were carried out.

The incidence rate of melanoma increased with 4.1% (95% confidence interval 3.6–4.5) annually. Incidence rates of both thin melanomas (≤1 mm) and thick melanomas (>4 mm) increased since 1989. Mortality rates increased mainly in older patients (<65 years). Ten-year relative survival of males improved significantly from 70% in 1989–1993 to 77% in 2004–2008 (P > 0.001) and for females the 10-year relative survival increased from 85% to 88% (P > 0.01). Recently diagnosed patients had a better prognosis even after adjusting for all known prognostic factors.

Since incidence of melanomas among all Breslow thickness categories increased as well as the mortality rates, the melanoma epidemic in The Netherlands seems to be real and not only due to overdiagnosis.

Incidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancer outcomes.

To develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older.

Pilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months.

Randomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline.

Men 50 years or older can successfully be recruited to a video-based intervention trial with the aim to reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior.

Incidence and mortality of melanoma have increased among men and women in Europe. We analysed the incidence and mortality of cutaneous melanoma (CM) in Northern Ireland. Three thousand eight hundred and thirty-seven incident cases of CM were reported to the Northern Ireland Cancer Registry (NICR) from 1984 to 2006 and 1177 melanoma deaths occurred from 1955 to 2007. Trends were analysed using joinpoint regression and a negative binomial model was fitted to test the linear trends for incidence adjusted for calendar year, age, sex and Breslow thickness. Age-adjusted incidence rates of CM increased significantly in both men and women (estimated annual percent change (EAPC): 4.8% and 2.5%, respectively). The increase was essentially due to thin melanoma (<1 mm). In contrast, there was a stabilisation of incidence of thick melanomas (⩾4 mm) in men and suggestion of a decrease in incidence of thick melanomas in women (EAPC: –1.5, 95% confidence interval (CI) –3.6;0.6). Mortality rates increased steadily in men over the whole period 1955–2004 (EAPC: 1.8%, 95% CI 1.1;2.5) whereas in women it increased until 1980 and decreased after (EAPC: –1.0%, 95% CI –2.5;0.6). We report for the first time a downward shift in all age mortality after steady increases but for women only. The plausibility of this shift is supported by similar downward trend in thick melanoma incidence in females only. Although there has been an active sun protection programme in Northern Ireland since 1990, the reason for the changes in female mortality which predates the programme remains to be fully understood.