Incidence and mortality of melanoma in situ and malignant melanoma in England between 2001 and 2020

BACKGROUND: An increase in the incidence of melanoma has been reported globally since the late twentieth century, while mortality from melanoma is no longer increasing in England and other countries. Improved therapeutics have reduced mortality. However, this phenomenon implicates 'overdiagnosis', where thinner melanomas of unclear malignant potential are being diagnosed possibly due to 'diagnostic drift'. OBJECTIVES: To assess the age-standardized and age-specific incidence and mortality trends for melanoma in situ (MIS) and malignant melanoma (MM) in England between 2001 and 2020 by age and gender. METHODS: We analysed routinely collected data from the National Disease Registration Service for MIS and MM in England between 2001 and 2020. We used joinpoint regression analysis to calculate the trends and average annual percentage change (APC) in age-standardized (using the 2013 European Standard Population) incidence (EASIR) and mortality (EASMR) and age-specific incidence (ASIR) and mortality (ASMR) rates, by age and gender per 100 000 person years (PYs). RESULTS: Between 2001 and 2020, 86 792 cases of MIS and 220 286 cases of MM were recorded in England. The EASIR (per 100 000 PYs) for MM increased most rapidly during 2001-6 (from 14.6 to 19.6; APC 6.3%); the rate of increase slowed during 2006-14 (APC 4.1%; EASIR2014 26.7) and decelerated further between 2014 and 2019 (APC 1.4%; EASIR2019 28.7). The EASIR for MIS (per 100 000 PYs) increased rapidly during 2001-15 (from 4.5 to 12.5; APC 7.5%) and subsequently slowed between 2015 and 2019 (to EASIR2019 13.3; APC 1.9%). In individuals 0-24 years old, the ASIR of MM and MIS has been decreasing since the late 2000s, whereas the ASIR of MM in those aged > 50 years is rising, with the greatest increases seen in those aged > 70 years. Since the early 2010s, EASMRs from MM have remained higher in men. ASMRs have reduced in adults < 74 years of age; however, rates have continued to increase in those > 75 years old. CONCLUSIONS: The deceleration in the incidence rates of MM and MIS may be due to stabilization of any diagnostic drift, ethnicity diversity and reduced sun-seeking behaviours, particularly in younger generations. Mortality rates from MM have decreased since therapeutic developments in the early 2010s, and in younger generations before this. MM incidence and mortality are increasing most rapidly in men aged > 75 years, the age group with the highest incidence and expected growth in the future. These results support the importance of early melanoma detection, public health sun-awareness campaigns and better melanoma diagnostics.