Burden of disease due to cutaneous melanoma has increased in the Netherlands since 1991.

BACKGROUND: The burden of disease, describing loss of health and death due to a disease, has not been fully studied for melanoma in the general population over time. OBJECTIVES: To determine the burden of disease due to melanoma in the Netherlands. METHODS: Age- and sex-specific incidence data from all patients with melanoma in the Netherlands between 1991 and 2010 were obtained from the Netherlands Cancer Registry. Melanoma-specific mortality and life expectancy data were obtained from Statistics Netherlands. Melanoma duration was calculated using the DISMOD software from the World Health Organization. The years of life lived with disability (YLD) and years of life lost (YLL) due to melanoma were calculated using Dutch disability weights, incidence and mortality of melanoma, and the life expectancy from the general population. The number of disability-adjusted life-years (DALYs) was estimated by adding YLD and YLL. RESULTS: The world-standardized incidence rates of melanoma have more than doubled for both men (7·1 per 100 000 inhabitants in 1991 to 17·0 in 2010) and women (9·4 per 100 000 inhabitants in 1991 to 19·8 in 2010). Likewise, the burden of melanoma to society has increased rapidly. The YLD for men increased from 4795 (1991-4) to 12 441 (2007-10), and for women from 7513 (1991-4) to 16 544 (2007-10). In 2007-10 the total YLL due to melanoma was 30 651 for men and 26 244 for women compared with 17 238 and 16 900, respectively, in 1991-4. The DALYs increased by 96% for men, from 22 033 (1991-4) to 43 092 (2007-10), and by 75% for women, from 24 413 (1991-4) to 42 788 (2007-10). CONCLUSIONS: Melanoma is becoming a great burden to Dutch society.

Melanoma incidence and exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.

A reduced incidence of nonmelanoma skin cancer among users of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARb) has been reported. A similar effect is suggested for cutaneous melanoma. We aimed to investigate the possible association between use of ACEi and ARb and the risk of cutaneous melanoma. A general population-based case control study with the PHARMO database, containing drug-dispensing records from community pharmacies and the national pathology database (PALGA) was conducted. Cases were patients with a primary cutaneous melanoma between January 1st 1991 and December 14th 2004, aged > or =18 years and having > or =3 years of follow-up prior to diagnosis. Finally, 1272 cases and 6520 matched controls were included. Multivariable conditional logistic regression showed no statistically significant associations between the incidence of melanoma and the use of ACEi (adjusted OR=1.0, 95%CI: 0.8-1.3) or ARb (adjusted OR=1.0, 95%CI: 0.7-1.5). Thus, in this study, the use of ACEi or ARb does not seem to protect against the development of cutaneous melanoma. However, we cannot exclude an association between ACEi and ARb exposure and an increased or decreased incidence of cutaneous melanoma.

Estrogens, oral contraceptives and hormonal replacement therapy increase the incidence of cutaneous melanoma: a population-based case-control study.

BACKGROUND: Multiple studies showed conflicting results on the association between oral contraceptive (OC) use and the development of cutaneous melanoma (CM). We investigated the association between estrogen use and CM incidence. PATIENTS AND METHODS: Data from PHARMO Pharmacy database and PALGA, the pathology database in The Netherlands, were linked. Women, >or=18 years, with a pathology report of a primary CM from 1 January 1991 to 14 December 2004 and >or=3 years of follow-up before CM diagnosis were eligible cases. Controls were matched for age and geographic region. Multivariate logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between CM incidence and estrogen use, OCs and hormonal replacement therapy (HRT), separately. RESULTS: In total, 778 cases and 4072 controls were included. CM risk was significantly associated with estrogen use (>or=0.5 year; adjusted OR = 1.42, 95% CI 1.19-1.69). This effect was cumulative dose dependent (P trend < 0.001). CM risk was also significantly associated with the use of HRT (>or=0.5 year: OR = 2.08; 95% CI 1.37-3.14) and OC (>or=0.5 year: OR = 1.28; 95% CI 1.06-1.54). CONCLUSION: Our study suggests a cumulative dose-dependent increased risk of CM with the use of estrogens.

Is statin use associated with a reduced incidence, a reduced Breslow thickness or delayed metastasis of melanoma of the skin?

BACKGROUND: Statins show anticancer activity in melanoma cells. We investigated the association between statins and incidence and Breslow thickness of cutaneous melanoma (CM). METHODS: Data were used from PHARMO, a pharmacy database, and PALGA, a pathological database, in the Netherlands. Cases had a primary CM diagnosis between January 1st 1991 and December 14th 2004, were 18 years and had 3 years of follow up in PHARMO before CM diagnosis. Controls were matched for gender, date of birth and geographic region. Analyses were adjusted for age, gender, year of diagnosis, number of medical diagnoses and the use of NSAIDs and oestrogens. FINDINGS: Finally, 1318 cases and 6786 controls were selected. CM risk was not associated with statin use (> or = 0.5 years) (adjusted odds ratio (OR)=0.98, 95% confidence interval (CI)=0.78-1.2). However, statin use was associated with a reduced Breslow thickness (-19%, 95% CI=-33, -2.3, p=0.03). CONCLUSION: Our study suggests protective effects of statins on melanoma progression.