The epidemiology of cutaneous malignant melanoma: aetiology and European data

Increases in cutaneous malignant melanoma (CMM) incidence and mortality rates have occurred in the last decades in virtually all white populations, more markedly in those which permanently (immigrants) or temporarily (tourists/vacationers) reside in very sunny areas distant from their original living environment. The strong relationship between sex and site of CMM in these upward trends (ie trunk in males, lower limbs and, more recently, trunk as well in females) points to intense intermittent ultraviolet light exposure as the cause of the CMM epidemic. In Europe the highest rates of melanoma are seen in Denmark, The Netherlands, the United Kingdom, Ireland and Germany, where many individuals have light complexion with tendency to burn. Increases of 2 to 7% per year in mortality rates appeared earlier in these countries, but were subsequently seen also in relatively low-risk areas such as southern European countries. The interpretation of data from case-control studies is, however, hampered by the difficulties in quantifying retrospectively CMM risk correlates (ie host factors, sun exposure, clothing habits, sunburns etc) in various periods during the life span.