Editor—Welch et al say that the increased incidence of cutaneous melanoma is a result of overdiagnosis because of increased diagnostic scrutiny, rather than an increase in the true occurrence.1 They observed that incidence rates of melanoma among American citizens aged 65 and older were strongly correlated with biopsy rates and that mortality from melanoma remained stable.
We wish to comment on this from a European perspective. Although increased biopsy rates have undoubtedly emerged and contributed to increased detection of melanomas, there are indications, at least in Europe, that part of the increase in melanoma incidence is true. Mortality due to melanoma in Europe was not stable, pointing to real increases in the incidence of melanoma.
In many European populations death rates from melanoma have been, at least up to 1997 and in the Netherlands also up to 2002 (figure), continuously and significantly increasing over time in all age categories, but especially among elderly men.2,3
Figure 1.
Age specific incidence of and mortality from cutaneous malignant melanoma in the Netherlands, 1950-2005
These increases affected young people (aged 25-49) in the magnitude of 2-3% per year in some north and west European countries and up to 8% in Spain. At older ages, more populations exhibited increases; in men above age 70 these varied between 2.7% (Netherlands) and 7.5% (Spain) yearly and in elderly women between 0.8% (Norway) and 7.7% (Spain).
Moreover, in many populations increases in incidence and mortality have been observed for up to five decades,2 which also argues in favour of at least part of the increases in melanoma incidence being real. For biopsy rates to cause the observed linear increases over time, they would have to have been increasing linearly for decades, which we find unlikely.
When the observed increases in mortality from malignant melanoma in Europe, mainly among elderly men, are taken into account, part of the observed increases in melanoma incidence seems to be “real.”
Competing interests: None declared.
References
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