To the Editor:
A previous study conducted by our team found a striking increase in melanoma incidence among young adults (aged 18-39 years) between 1970 and 2009. Conclusions from that study suggested this trend could, in part, be impacted by increased exposure to tanning beds.1 In this article, we provide an update on the incidence of melanoma in young adults from the same population-based cohort by expanding the time period to include 2010-2020.
Using the Rochester Epidemiology Project data-base (a multicenter medical records–linkage system encompassing the Olmsted County population), patients living in Olmsted County, Minnesota aged 18 to 39 years with a first lifetime diagnosis of cutaneous melanoma between January 1, 1970 and December 31, 2020 were identified.
A total of 422 incident cases were identified. The age- and sex-adjusted incidence rate increased from 4.2 (95% CI, 2.0-6.4) per 100,000 person-years in 1970-1979 to 27.7 (95% CI, 23.1-32.2) per 100,000 person-years in the period of 2011-2020 (6.6-fold increase). There was an 8.4-fold increase in women and a 4.6-fold increase in men during this time. In recent years (2005-2009 vs 2015-2020), the incidence has not significantly changed in women (54.3 vs 43.4, 0.8-fold increase; P = .16) or men (22.8 vs 18.6, 0.8-fold increase; P = .47).
Supplementary Table I (available via Mendeley at https://data.mendeley.com/datasets/36r9rvp26p/1) summarizes the demographic and clinicopathologic characteristics. Age-adjusted incidence rates by sex and calendar period at diagnosis are presented in Fig 1.
Fig 1.
Age-adjusted incidence of cutaneous melanoma per 100,000 person-years in Olmsted County, Minnesota from 1970-2020 for persons aged 18 to 39 years by sex and calendar period. Bars represent 95% CIs.
No melanoma-specific mortalities occurred due to melanoma in situ. Among the 349 patients with invasive melanoma, 20 deaths were documented, including 11 due to melanoma. The median follow-up of all patients alive at last follow-up was 10.1 (IQR, 4.1-17.8) years. The cause-specific survival continues to improve for those patients who were more recently diagnosed.
Our retrospective population-based epidemiologic study demonstrated that the incidence in men and women has stabilized over the last 15 years in this cohort. Despite this stabilization, melanoma incidence in 2015-2020 continues to be 8- and 4-fold higher than it was in 1970-1979 among young women and men, respectively.
Although it is difficult to draw firm conclusions regarding changes in external pressures accounting for these trends, one possible explanation for the recent stabilization in young females is the decreased exposure of this population to tanning. Previous data from 2010 have shown that indoor tanning use was the highest among young (aged 18-25 years) Midwestern women.2 In recent years, there has been a reduction of indoor tanning bed use, especially among young women.2 Reasons to account for this shift in indoor tanning behavior may include the 2010 implementation of a federal 10% excise tax on indoor tanning and the 2014 Minnesota state law prohibiting indoor tanning bed use among minors.3,4
There are several important limitations of this study, many of which are intrinsic to the retrospective design. The results may not be generalizable, as the population was comprised of mostly Caucasian, well-educated individuals.5 Further nationwide data are required to draw definitive conclusions regarding melanoma trends in the United States.
Funding sources:
Mayo Clinic Department of Dermatology.
This study used the resources of the Rochester Epidemiology Project (REP) medical records-linkage system, which is supported by the National Institute on Aging (NIA; AG 058738), by the Mayo Clinic Research Committee, and by fees paid annually by REP users. The content of this article is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health (NIH) or the Mayo Clinic.
Footnotes
IRB approval status: Reviewed and approved by Mayo Clinic IRB (#21-000552). Reviewed and approved by Olmsted Medical Center IRB (#004-OMC-21).
Conflicts of interest
None disclosed.
REFERENCES
- 1.Reed KB, Brewer JD, Lohse CM, Bringe KE, Pruitt CN, Gibson LE. Increasing incidence of melanoma among young adults: an epidemiological study in Olmsted County, Minnesota. Mayo Clin Proc. 2012;87(4):328–334. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Guy GP Jr, Watson M, Seidenberg AB, Hartman AM, Holman DM, Perna F. Trends in indoor tanning and its association with sunburn among US adults. J Am Acad Dermatol. 2017;76(6):1191–1193. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Indoor Tanning Services; Cosmetic Services; Excise Taxes. Federal Register Volume 75, Issue 114 (June 15, 2010). Accessed April 16, 2023. https://www.govinfo.gov/app/details/FR-2010-06-15/2010-14398 [Google Scholar]
- 4.Use By Minors Prohibited. Minnesota Legislators. Accessed April 16, 2023. https://www.revisor.mn.gov/statutes/cite/325H.085. https://www.revisor.mn.goV/laws/2014/0/291/
- 5.St Sauver JL, Grossardt BR, Leibson CL, Yawn BP, Melton LJ III, Rocca WA. Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project. Mayo Clin Proc. 2012;87(2):151–160. [DOI] [PMC free article] [PubMed] [Google Scholar]