The Melanoma Project

Proposal for a range of in-depth studies of the epidemiology of melanoma.

In the following, the titles of a series of projects are listed with some simple explanatory notes.
A draft protocol will be sent to those who communicate an interest to participate, and a final protocol will be agreed among the participating cancer registries.

Projects based on the data already sent to the AIRTUM database.

1. Incidence of a second cancer in patients with skin cancer. This is a cohort study making use of existing data in the database (incidence date, date of the last follow-up and incidence date of the second cancer), and the specific incidence rates per cancer registry, sex and ?period per la creazione degli attesi?. The intention is to verify the increase in risk already highlighted in the literature (e.g., skin cancer, lymphoma etc.).
2. Seasonality of diagnosis. Seasonality of the diagnosis of melanoma, presumably linked to the greater visibility of the skin in the summer months, has been noted. The basis of the study, which will be restricted to a recent period, is given by the incidence date. It will be interesting to establish if there is a difference between superficial and nodular forms and across sites (for the registries that have such information).
3. Incidence trends per histological type. (?periodo e RT da selezione?) It seems that the marked growth in incidence seen in recent years is mainly, if not totally, due to the superficial form of diffusion, and not other forms.
4. Analysis of trends with the approach ‘age - period - cohort’ (?selezione periodo e RT?). The forecasting of incidence rates for the younger age classes by estimation of past incidence rates.

Projects requiring additional data to that sent to the AIRTUM database.

The principal variables in any in-depth study of melanoma are those concerning staging that have been used, for many years, in anatomical-pathologists’ reports, that is,
- Clark level
- Breslow depth.

Other variables are also important but can be estimated only if available from the cancer registry:
- Margins
- Vascolar infiltration
- Regression
- Sentinel lymph node (carried out – yes/no, positive – yes/no, subsequent lymphadenectomy with pN.
- And so on, through discussion amongst dermatologist colleagues.

The availability of these additional variables would enable particularly interesting studies in:
1) Changes of the distribution of stages with time (selected registries)
2) Geographical comparison of the stage at diagnosis in the north, centre and south of Italy
3) Analysis of survival focussed on prognostic factors
4) Use of the CART method for the definition of individual prognostic profiles
5) Information on the execution of sentinel lymph node (and on stage N).

Results

The aim is to achieve high visibility for the association, through scientific articles from individual cancer registries and / or presentation at conventions.

Autorship

All of the participants from cancer registries will be acknowledged among the authors.
If the number of authors (from registries) has been restricted, this will be stated, otherwise a collective title will be used, such as “AIRTUM Melanoma working group” which will contain one or more names for each participating registry and the names of those, not connected to registries, who have actively contributed to the work.

Some of the prposed projects are inspired by a series of work about melanoma:
1. Crocetti E, Carli P, Miccinesi G. Melanoma incidence in central Italy will go on increasing also in the near future: A registry-based, age-period-cohort analysis. Eur J Cancer Prev 2007;16(1): 50-54.
2. Carli P, Nardini P, Chiarugi A et al. Predictors of skin self-examination in subjects attending a pigmented lesion clinic in Italy. J Eur Acad Dermatol Venereol 2007; 21(1): 95-99.
3. Crocetti E, Mangone L, Scocco GL, Carli P. Prognostic variables and prognostic groups for malignant melanoma. The information from Cox and Classification And Regression Trees analysis: an Italian population-based study. Melanoma Res 2006; 16(5): 429-33.
4.Carli P, Ghigliotti G, Gnone M et al. Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: an Italian multicenter survey. J Am Acad Dermatol 2006; 55(2): 256-62.
5. de Giorgi V, Crocetti E, Carli P. Cutaneous melanoma. Lancet 2005;365(9476): 2003.
6. Crocetti E, Carli P. Seasonal variation in the diagnosis of cutaneous melanoma and non-cutaneous malignancies: an Italian population-based study. Melanoma Res 2005; 15(1): 69-72.
7. Carli P, De Giorgi V, Crocetti E, Caldini L, Ressel C, Giannotti B. Diagnostic and referral accuracy of family doctors in melanoma screening: effect of a short formal training. Eur J Cancer Prev 2005; 14(1): 51-55.
8. Carli P, Nardini P, Crocetti E, De Giorgi V, Giannotti B. Frequency and characteristics of melanomas missed at a pigmented lesion clinic: a registry-based study. Melanoma Res 2004; 14(5): 403-07.
9. Carli P, De Giorgi V, Crocetti E et al. Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997-2001. Br J Dermatol 2004; 150(4): 687-92.
10. Carli P, de Giorgi V, Chiarugi A et al. Addition of dermoscopy to conventional naked-eye examination in melanoma screening: a randomized study. J Am Acad Dermatol 2004; 50(5): 683-89.
11. Crocetti E, Carli P. Risk of second primary cancers, other than melanoma, in an Italian population-based cohort of cutaneous malignant melanoma patients. Eur J Cancer Prev 2004; 13(1): 33-37.
12. Crocetti E, Carli P. Only superficial spreading melanoma is causing the melanoma epidemics? Eur J Epidemiol 2004; 19(1): 91-92.
13. Crocetti E, Carli P. Unexpected reduction of mortality rates from melanoma in males living in central Italy. Eur J Cancer 2003; 39(6): 818-21.
14. Crocetti E, Carli P. Changes from mid-1980s to late 1990s among clinical and demographic correlates of melanoma thickness. Eur J Dermatol 2003; 13(1): 72-75.