engleski

Epidemiology and risk factors for melanomas in Croatia

Melanoma, a skin cancer has been in the focus of interest for the last 40 years. Considering the generally rising incidence of melanoma, all public health institutions should intensify the early detection and education program. Records on 3.487 nevo cellular nevi of various histologic types observed in patients from 1979 till 1998 at the Department of Dermatology and Venerology Zagreb University Hospital Center and School of Medicine revealed the most frequent type of nevocellular nevi in our casuistic (66.62%) with almost equal prevalence in men and women, occurring at a mean age of 34.31, and localized in about 69.78% of cases on the trunk. What are the risk factors for malignant melanoma (MM)? It is now generally accepted that sunlight is a causal factor in the development of MM (prolonged exposure) ; skin color and latitude gradient ; large congenital nevi ; atypical (dysplastic nevi), the history of familial MM and history of the syndrome of dysplastic nevi. Approximately 10% of MM cases occur in individuals with a familial predisposition, often in association with clinical atypical (dysplastic) nevi, which are a major precursor of melanoma lesions. The four major growth patterns of MM are: lentigo maligna melanoma (LMM), superficial spreading melanoma (SSM), nodular melanoma (NM) and acrolentiginous malignant melanoma (ALMM). Other MM variants are: MM of mucosa and desmoplastic - neurotrophic MM. The clinicopathologic stage of the disease is a very important prognostic factor in patients with cutaneous melanoma. So, the 5-year survival rate is 75-85% in Stage I and 35-50% in Stage II patients, while the mean survival in stage III patients is 6 months. To increase the survival of MM patients are the: early diagnosis, patients’ management ; preventive treatment and anti-metastatic therapy. Also, reporting of new cases of MM to the Croatian Institute of Public Health is of utmost importance to keep a statistic of the incidence and mortality of melanoma in Croatia. In Zagreb, a campaign should be initiated to reduce the proportion of thick melanoma which excision of early melanoma. Self-inspection of the skin is also needed to decrease the mortality ratio. The patients should be properly instructed how to recognize and follow up particular nevus alterations (ABCDE rule of melanoma!). The largest atypical mole should be identified, measured, shown to the patient, and instruct him how to compare it with other moles. Self-inspection of the skin should be performed once a month and every mole found to have undergone and change in the meantime should be shown to the physician. The patient should visit dermatologist and keep photo documentation at least once a year for life. Preventive excision should be carried and in case of a lesion suspect for MM found on the initial or any control examination, or if a dysplastic nevus is localized at scalp or intergluteal region. The incidence and mortality rate of skin melanoma have been on an increase in Croatia during 40 years (1968-1998 – 300% and 310%) (7, 5% and 6.8% per year on an average), respectively. A rapid in the incidence of melanoma has been reported for many countries (by 4% to 8% per year over last 30 years), however, a decrease in the mortality rate, especially in young age groups, probably related to earlier detection of this disease, has also been observed. In Republic of Croatia, malignant melanoma accounts for 1.9% of the total incidence of carcinoma per year, in USA to 3% in Japan 1% and in Australia 11%-12%. The overall incidence of malignant melanoma (MM) in 1998, 149 patients (84 male and 65 women) died from MM in Croatia, yielding a mortality rate of 3.1/100.000. The incidence of MM rises with age. It does not occur at a very young age, while highest rates have been recorded in the oldest age groups. An increase in the incidence of MM has been observed in all age groups. In 2002 there was incidence of 396 patients (rate 8.9/100.000) in Croatia. The most common localization of skin MM is the trunk in men and lower extremities in woman. Geographic differences have been observed in the distribution of MM in Croatia with the highest prevalence in the Dubrovnik, Zagreb and Zadar regions. In comparison with other countries of the world and Europe, Croatia has a lower rate of MM.

melanomas; risk factors; epidemiology public ehalth institutions

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