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content="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006t1_1652203168.58538.png?Expires=2147483647&Signature=cJ18vOScU4la6KYMxxS4CQC-YGvUBmsT7gN7sfH97gBPwt4cIMw7eAhpeeVEujGPcON43jWPEu8F1HXuH-xGOFLOYFKRwl3bXAj1X9ZrFoA~0lLV6Jhb2NOL9d73v9vLBxFcynyczeL9L85OJHFmVyZ1kphu94Q~E--sUBZn6iTme0Hk1NTAcvDU-4K5aCOWn9vPflzl17jgxmcrv3moVRm5y5mkto5gW0lW6i7CxN~eNCmqG26dOwEWlCT9B~ffsVR16pV4JOllrWjWKk-S~Mk6QoUnXpJkhXO4kzMToMyQwUxddLjjL4UKDXULnkWlZTkHJ6fZj11O-cm0Z2aBQA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <script type="application/ld+json"> { "@context": "https://schema.org/", "@type": "Article", "headline": "Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040", "author": "Melina Arnold, PhD", "url": "https://jamanetwork.com/journals/jamadermatology/fullarticle/2790344", "datePublished": "2022-05-01", "description": "This epidemiological assessment uses the GLOBOCAN database to evaluate the numbers of new cases and deaths due to cutaneous melanoma globally and 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name="citation_author_institution" content="Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France" /><meta name="citation_author" content="Mathieu Laversanne" /><meta name="citation_author_institution" content="Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France" /><meta name="citation_author" content="Jerome Vignat" /><meta name="citation_author_institution" content="Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France" /><meta name="citation_author" content="Salvatore Vaccarella" /><meta name="citation_author_institution" content="Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France" /><meta name="citation_author" content="Filip Meheus" /><meta name="citation_author_institution" content="Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France" /><meta name="citation_author" content="Anne E. Cust" /><meta name="citation_author_institution" content="The Daffodil Centre, The University of Sydney with Cancer Council New South Wales, Sydney, Australia" /><meta name="citation_author_institution" content="Melanoma Institute Australia, The University of Sydney, Sydney, Australia" /><meta name="citation_author" content="Esther de Vries" /><meta name="citation_author_institution" content="Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia" /><meta name="citation_author" content="David C. Whiteman" /><meta name="citation_author_institution" content="Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia" /><meta name="citation_author" content="Freddie Bray" /><meta name="citation_author_institution" content="Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France" /><meta name="citation_title" content="Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040" /><meta name="citation_firstpage" content="495" /><meta name="citation_lastpage" content="503" /><meta name="citation_doi" content="10.1001/jamadermatol.2022.0160" /><meta name="citation_keyword" content="epidemiology" /><meta name="citation_keyword" content="melanoma" /><meta name="citation_keyword" content="malignant melanoma, cutaneous" /><meta name="citation_keyword" content="cancer" /><meta name="citation_abstract" content="<h3>Importance</h3><p>Despite many cases being preventable, cutaneous melanoma remains the most serious skin cancer worldwide. Understanding the scale and profile of the disease is vital to concentrate and reinforce global prevention efforts.</p><h3>Objective</h3><p>To examine global patterns of cutaneous melanoma in 2020 and to provide projected estimates of cases and deaths by 2040.</p><h3>Design, Setting, and Participants</h3><p>This population-based study used the GLOBOCAN 2020 database for global epidemiological assessment of new cases and deaths due to invasive melanoma.</p><h3>Main Outcomes and Measures</h3><p>Age-standardized incidence and mortality rates were calculated per 100 000 person-years by country, world region, and 4-tier level of human development. Estimated numbers of cases and deaths were calculated for the year 2040.</p><h3>Results</h3><p>A worldwide total of 325 000 new melanoma cases (174 000 males, 151 000 females) and 57 000 deaths (32 000 males, 25 000 females) was estimated for 2020. Large geographic variations existed across countries and world regions, with the highest incidence rates among males (42 per 100 000 person-years) and females (31 per 100 000 person-years) observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 person-years for females), and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 person-years for females). Melanoma continued to be rare in most African and Asian countries, with incidence rates commonly less than 1 per 100 000 person-years. Mortality rates peaked at 5 per 100 000 person-years in New Zealand, and geographic variations were less pronounced than for incidence. Melanoma was more frequent among males than females in most world regions. If 2020 rates continue, the burden from melanoma is estimated to increase to 510 000 new cases (a roughly 50% increase) and to 96 000 deaths (a 68% increase) by 2040.</p><h3>Conclusions and Relevance</h3><p>This epidemiological assessment suggests that melanoma remains an important challenge to cancer control and public health globally, especially in fair-skinned populations of European descent.</p>" /><meta name="citation_journal_title" content="JAMA Dermatology" /><meta name="citation_journal_abbrev" content="JAMA Dermatol" /><meta name="citation_volume" content="158" /><meta name="citation_issue" content="5" /><meta name="citation_publication_date" content="2022/05/01" /><meta name="citation_issn" content="2168-6068" /><meta name="citation_publisher" content="American Medical Association" /><meta name="citation_reference" content="citation_title=International trends in the incidence of malignant melanoma 1953-2008—are recent generations at higher or lower risk?; citation_author=Erdmann F; citation_author=Lortet-Tieulent J; citation_author=Schüz J; citation_journal_title=Int J Cancer; citation_year=2013; citation_volume=132; citation_issue=2; citation_pages=385-400; " /><meta name="citation_reference" content="citation_title=Trends in incidence and predictions of cutaneous melanoma across Europe up to 2015.; citation_author=Arnold M; citation_author=Holterhues C; citation_author=Hollestein LM; citation_journal_title=J Eur Acad Dermatol Venereol; citation_year=2014; citation_volume=28; citation_issue=9; citation_pages=1170-1178; " /><meta name="citation_reference" content="citation_title=A review of human carcinogens—part D: radiation.; citation_author=WHO International Agency for Research on Cancer Monograph Working Group; citation_author=El Ghissassi F; citation_author=Baan R; citation_author=Straif K; citation_journal_title=Lancet Oncol; citation_year=2009; citation_volume=10; citation_issue=8; citation_pages=751-752; " /><meta name="citation_reference" content=" citation_year=2012; " /><meta name="citation_reference" content="citation_title=Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012.; citation_author=Arnold M; citation_author=de Vries E; citation_author=Whiteman DC; citation_journal_title=Int J Cancer; citation_year=2018; citation_volume=143; citation_issue=6; citation_pages=1305-1314; " /><meta name="citation_reference" content="citation_title=Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study.; citation_author=Fidler MM; citation_author=Gupta S; citation_author=Soerjomataram I; citation_author=Ferlay J; citation_author=Steliarova-Foucher E; citation_author=Bray F; citation_journal_title=Lancet Oncol; citation_year=2017; citation_volume=18; citation_issue=12; citation_pages=1579-1589; " /><meta name="citation_reference" content="citation_title=The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031.; citation_author=Whiteman DC; citation_author=Green AC; citation_author=Olsen CM; citation_journal_title=J Invest Dermatol; citation_year=2016; citation_volume=136; citation_issue=6; citation_pages=1161-1171; " /><meta name="citation_reference" content="citation_title=Epidemiology of cutaneous melanoma and keratinocyte cancer in white populations 1943-2036.; citation_author=Garbe C; citation_author=Keim U; citation_author=Gandini S; citation_journal_title=Eur J Cancer; citation_year=2021; citation_volume=152; citation_pages=18-25; " /><meta name="citation_reference" content="citation_title=Age-specific incidence of melanoma in the United States.; citation_author=Paulson KG; citation_author=Gupta D; citation_author=Kim TS; citation_journal_title=JAMA Dermatol; citation_year=2020; citation_volume=156; citation_issue=1; citation_pages=57-64; " /><meta name="citation_reference" content="citation_title=Long-term deaths from melanoma according to tumor thickness at diagnosis.; citation_author=Baade PD; citation_author=Whiteman DC; citation_author=Janda M; citation_journal_title=Int J Cancer; citation_year=2020; citation_volume=147; citation_issue=5; citation_pages=1391-1396; " /><meta name="citation_reference" content="citation_title=Cancer statistics for the year 2020: an overview.; citation_author=Ferlay J; citation_author=Colombet M; citation_author=Soerjomataram I; citation_journal_title=Int J Cancer; citation_year=2021; " /><meta name="citation_reference" content="citation_title=Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.; citation_author=Sung H; citation_author=Ferlay J; citation_author=Siegel RL; citation_journal_title=CA Cancer J Clin; citation_year=2021; citation_volume=71; citation_issue=3; citation_pages=209-249; " /><meta name="citation_reference" content="International Agency for Research on Cancer: Global Cancer Observatory. Cancer today. Published 2021. Accessed April 28, 2021. https://gco.iarc.fr/today/home " /><meta name="citation_reference" content="United Nations Statistics Division. Standard country or area codes for statistical use (M49): aggregated. Published 2021. Accessed April 28, 2021. " /><meta name="citation_reference" content="citation_title=Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods.; citation_author=Ferlay J; citation_author=Colombet M; citation_author=Soerjomataram I; citation_journal_title=Int J Cancer; citation_year=2019; citation_volume=144; citation_issue=8; citation_pages=1941-1953; " /><meta name="citation_reference" content="citation_title=Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.; citation_author=Ferlay J; citation_author=Soerjomataram I; citation_author=Dikshit R; citation_journal_title=Int J Cancer; citation_year=2015; citation_volume=136; citation_issue=5; citation_pages=E359-E386; " /><meta name="citation_reference" content="citation_title=Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.; citation_author=Ferlay J; citation_author=Shin HR; citation_author=Bray F; citation_author=Forman D; citation_author=Mathers C; citation_author=Parkin DM; citation_journal_title=Int J Cancer; citation_year=2010; citation_volume=127; citation_issue=12; citation_pages=2893-2917; " /><meta name="citation_reference" content="citation_author=Segi M; citation_author=Kurihara M; citation_publisher=Tohoku University of Medicine, ; citation_title=Cancer Mortality for Selected Sites in 24 Countries (1950-1957); citation_year=1960; " /><meta name="citation_reference" content="citation_author=Doll R; citation_author=Payne P; citation_author=Waterhouse J; citation_publisher=Springer, ; citation_title=Cancer Incidence in Five Continents: A Technical Report; citation_year=1966; " /><meta name="citation_reference" content="citation_title=Cancer incidence in five continents. cumulative rate and cumulative risk.; citation_author=Day NE; citation_journal_title=IARC Sci Publ; citation_year=1992; citation_issue=120; citation_pages=862-864; " /><meta name="citation_reference" content="citation_author=United Nations Development Programme; citation_publisher=United Nations, ; 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figure-table-tab need-jobs-ad"> <div class="widget-ArticleFiguresAndTables widget-instance-AMA_Article_Figures_Tab"> <div class="figure-table-wrapper thm-bd-top"><div class="figure-label">Figure 1. Distribution of Melanoma Cases and Deaths by World Region in 2020, Both Sexes Combined</div><a id="doi220006f1" class="figure-table-anchor"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="doi220006f1" href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f1_1652203168.59535.png?Expires=1735230590&Signature=cpEomaHLEXcZ13X88g8oyhXYFTzVXgRi46GQsJvXY15XxPz-~6SknsINd7r-LHvS-G4~Jy7j6QEKVD-KYxDaYY5tblkLdkAdTK3-IhOTunRApQQfQfmziVUvlkdldf8EiKg-21bH8oLl9D6YMpo-Mt4dxjoZthOxAQF2AuC2YJ1CSprXISkyd6Fwtla2LOW5PEkW-4z-ELtmN3Bx-UtQAQqn1iPX6fZ5LRFr0MMfUYOBKtCoGjqHYJRW5BmmIqJv0x5AbsMf7hoqcJzdxaNT94x9lz~r9uhlsMWXhDUHmVwE9GAUhhdIIpabdV2VDpRjYZ5arqbGbohU0zGSvIRilw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="doi220006f1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f1_1652203168.59535.png?Expires=1735230590&Signature=cpEomaHLEXcZ13X88g8oyhXYFTzVXgRi46GQsJvXY15XxPz-~6SknsINd7r-LHvS-G4~Jy7j6QEKVD-KYxDaYY5tblkLdkAdTK3-IhOTunRApQQfQfmziVUvlkdldf8EiKg-21bH8oLl9D6YMpo-Mt4dxjoZthOxAQF2AuC2YJ1CSprXISkyd6Fwtla2LOW5PEkW-4z-ELtmN3Bx-UtQAQqn1iPX6fZ5LRFr0MMfUYOBKtCoGjqHYJRW5BmmIqJv0x5AbsMf7hoqcJzdxaNT94x9lz~r9uhlsMWXhDUHmVwE9GAUhhdIIpabdV2VDpRjYZ5arqbGbohU0zGSvIRilw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248411648&ar=2790344&imagename=&siteId=12" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f1_1652203168.59535.png?Expires=1735230590&Signature=cpEomaHLEXcZ13X88g8oyhXYFTzVXgRi46GQsJvXY15XxPz-~6SknsINd7r-LHvS-G4~Jy7j6QEKVD-KYxDaYY5tblkLdkAdTK3-IhOTunRApQQfQfmziVUvlkdldf8EiKg-21bH8oLl9D6YMpo-Mt4dxjoZthOxAQF2AuC2YJ1CSprXISkyd6Fwtla2LOW5PEkW-4z-ELtmN3Bx-UtQAQqn1iPX6fZ5LRFr0MMfUYOBKtCoGjqHYJRW5BmmIqJv0x5AbsMf7hoqcJzdxaNT94x9lz~r9uhlsMWXhDUHmVwE9GAUhhdIIpabdV2VDpRjYZ5arqbGbohU0zGSvIRilw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="doi220006f1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/m_doi220006f1_1652203168.59535.png?Expires=1735230590&Signature=Ti3GL8OWYdd8sv6b2rX7dbWTECJLPQKrOzo7W63H1zJv-9zo87Yo8P4sTo2YxMRGQ4W~LaNnfbY8J5~nULWjosnQYQuI7Z-1kcKUrGzzsc9MkdOUrC~mLBN0bBny-~xk6x4OeMedcnDBkmxbdyhX5OESuBYDPtrmq8vReANdu92HurwdV-9V-VuBzQtQ-yLPwUMfurD4-w42P71tWqabTmEojUwsKxHBcda8dHq6ZWPWl6JGBryt8G6t6RtFlvKecUEynEP~~7Z3FTdKhkJN8H9hmaMjw3aVRRFlARiz23j~8KImYsWkDePb-vD2SoceMB6jw9oM22o5gx88Po4pJA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Distribution of Melanoma Cases and Deaths by World Region in 2020, Both Sexes Combined" class="content-img lazy" path-from-xml="doi220006f1" /></a></div></div><div class="figure-caption clip-last-child"><p class="para">There were a total of 324 635 new cases and 57 043 deaths. Reproduced/adapted with permission from the International Agency for Research on Cancer/World Health Organization (<a href="https://gco.iarc.fr/today/home">https://gco.iarc.fr/today/home</a>).</p></div></div><div class="figure-table-wrapper thm-bd-top"><div class="figure-label">Figure 2. Age-Standardized Rates of Incidence and Mortality of Melanoma per 100 000 Person-Years, Both Sexes Combined</div><a id="doi220006f2" class="figure-table-anchor"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="doi220006f2" href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f2_1652203168.61037.png?Expires=1735230590&Signature=oAhXXLxxAyYoNE-v0Q2r-aRNbyaBSCCOOWDU7a5Qoeezp3OETdQhGcYE59Q7T0Dr0fd7IyHb~ojcTNoKCudl4CZ8n8MQ4JE5DM-uhA1ztTT5rcelcQe6EkdrH10GN-kG5riuSMsOxUOZGjUaDNRv1Imp9yPvdCPqV7QUoiJv4hWoSGqjJEU~9ffltZMHLHaAhKNOIJi9o1vTOHOt8ecU9oLGA5EBE2~BNNUdVgN2e6Cw1wc8xlpdGrNG8uosHaoH03SBe0sIdOWj~11xAwyVInyXY2OHzOsYWzbPylL0OURrV~qSLt0lqYEkus6Xo8lROjsZvd4voBafpqPnQY364g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="doi220006f2" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f2_1652203168.61037.png?Expires=1735230590&Signature=oAhXXLxxAyYoNE-v0Q2r-aRNbyaBSCCOOWDU7a5Qoeezp3OETdQhGcYE59Q7T0Dr0fd7IyHb~ojcTNoKCudl4CZ8n8MQ4JE5DM-uhA1ztTT5rcelcQe6EkdrH10GN-kG5riuSMsOxUOZGjUaDNRv1Imp9yPvdCPqV7QUoiJv4hWoSGqjJEU~9ffltZMHLHaAhKNOIJi9o1vTOHOt8ecU9oLGA5EBE2~BNNUdVgN2e6Cw1wc8xlpdGrNG8uosHaoH03SBe0sIdOWj~11xAwyVInyXY2OHzOsYWzbPylL0OURrV~qSLt0lqYEkus6Xo8lROjsZvd4voBafpqPnQY364g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248411651&ar=2790344&imagename=&siteId=12" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f2_1652203168.61037.png?Expires=1735230590&Signature=oAhXXLxxAyYoNE-v0Q2r-aRNbyaBSCCOOWDU7a5Qoeezp3OETdQhGcYE59Q7T0Dr0fd7IyHb~ojcTNoKCudl4CZ8n8MQ4JE5DM-uhA1ztTT5rcelcQe6EkdrH10GN-kG5riuSMsOxUOZGjUaDNRv1Imp9yPvdCPqV7QUoiJv4hWoSGqjJEU~9ffltZMHLHaAhKNOIJi9o1vTOHOt8ecU9oLGA5EBE2~BNNUdVgN2e6Cw1wc8xlpdGrNG8uosHaoH03SBe0sIdOWj~11xAwyVInyXY2OHzOsYWzbPylL0OURrV~qSLt0lqYEkus6Xo8lROjsZvd4voBafpqPnQY364g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="doi220006f2" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/m_doi220006f2_1652203168.61037.png?Expires=1735230590&Signature=0T6vT4ei5Dw4ADKHGkqYW5~2mTcUtVDfMpVhvD2NOmJQr-JRBYykXPZOsyKQbHn~Y2gO--rHj9jf6Tf~BjgYwj0KBN1HUV~IOD~45orJppyBZyxKUwkyCNl2eBIBLdJNr9ZjMZ1w7roDZoRBiaXzW6vrIpt4cVuh4VSaT5OYHEAF1OV2esGi20KD~6ii2vyl9WPShxN5o~nCmxFGYG5iZiB7jJpko7ggPOYBv7oqKDnCqXlOrkiubYnuy-TUr1vNJCfdcvIAx9DTnv4a2jxcIIHD~nz5ekGxBxOZDsaXnMeMjKjbU129L6WamhVrTLvnDA-Y6k3ajPac~IjDkWQLkQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Age-Standardized Rates of Incidence and Mortality of Melanoma per 100 000 Person-Years, Both Sexes Combined" class="content-img lazy" path-from-xml="doi220006f2" /></a></div></div><div class="figure-caption clip-last-child"><p class="para">ASR(W) represents age-standardized rate (world). Reproduced/adapted with permission from the International Agency for Research on Cancer/World Health Organization (<a href="https://gco.iarc.fr/today/home">https://gco.iarc.fr/today/home</a>).</p></div></div><div class="figure-table-wrapper thm-bd-top"><div class="figure-label">Figure 3. Estimated Numbers of Melanoma Cases and Deaths From 2020 to 2040, by Projection Scenario</div><a id="doi220006f3" class="figure-table-anchor"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="doi220006f3" href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f3_1652203168.62536.png?Expires=1735230590&Signature=aLjv-YWfkgU9aJGWQeubGcm80c8gV23DadmtTrWNbhGMPcOh7e~7QelgvEnUON4mvrJI0pKVuIbN914A0DAnKYUKj6SxYKWfqqBr75KegSAQPPQMliQNc5wnyFjAbr89NdD1-EnML0RGyVScuYggI5YDCPThvQ9maee-Mp93QN7T~FMsSCsVQM94cVcC6CZnh7F1lReCC1LZm6ViF8Ah276p9syIye08StrAsL5mHV8gVvlWPfcdZJ9Zz6Nr0G~DJAgfmIhMYfGrkrplzIc3Kz3XWGwSPE7ugOOru1iKrr4jRP2h7yWKbYRp6Zz9R5MjRKihPSH5ChtcbC-Xu8g57A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="doi220006f3" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f3_1652203168.62536.png?Expires=1735230590&Signature=aLjv-YWfkgU9aJGWQeubGcm80c8gV23DadmtTrWNbhGMPcOh7e~7QelgvEnUON4mvrJI0pKVuIbN914A0DAnKYUKj6SxYKWfqqBr75KegSAQPPQMliQNc5wnyFjAbr89NdD1-EnML0RGyVScuYggI5YDCPThvQ9maee-Mp93QN7T~FMsSCsVQM94cVcC6CZnh7F1lReCC1LZm6ViF8Ah276p9syIye08StrAsL5mHV8gVvlWPfcdZJ9Zz6Nr0G~DJAgfmIhMYfGrkrplzIc3Kz3XWGwSPE7ugOOru1iKrr4jRP2h7yWKbYRp6Zz9R5MjRKihPSH5ChtcbC-Xu8g57A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248411654&ar=2790344&imagename=&siteId=12" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006f3_1652203168.62536.png?Expires=1735230590&Signature=aLjv-YWfkgU9aJGWQeubGcm80c8gV23DadmtTrWNbhGMPcOh7e~7QelgvEnUON4mvrJI0pKVuIbN914A0DAnKYUKj6SxYKWfqqBr75KegSAQPPQMliQNc5wnyFjAbr89NdD1-EnML0RGyVScuYggI5YDCPThvQ9maee-Mp93QN7T~FMsSCsVQM94cVcC6CZnh7F1lReCC1LZm6ViF8Ah276p9syIye08StrAsL5mHV8gVvlWPfcdZJ9Zz6Nr0G~DJAgfmIhMYfGrkrplzIc3Kz3XWGwSPE7ugOOru1iKrr4jRP2h7yWKbYRp6Zz9R5MjRKihPSH5ChtcbC-Xu8g57A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="doi220006f3" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/m_doi220006f3_1652203168.62536.png?Expires=1735230590&Signature=IReYQQ6RD2j85H6LOJE1qVjV1MYR96LMg5-8y508xnl8m9X~hyE0J0ynnFhcjyK5aFtxeXMXjlu7mTA9LJKFRm6u1tWwtMw6lxaqhoeARv8kqkwsSLZtAZ4XdM1xW~pIsTyx1lQ6ORqANg4csKEFbgutM67gG54bAOBBJ-XCeTN650~OsNi6XqaIEmYvictPUPXsJQTgCiRAB9DNz09lyEAfKt4zUzIhbAitvNC0Nye9-Ep2hwBbA16WWw6YhBVJgBefAMkZyy9pMF1-kiT37DPEGFg4N~6pmkTU5PMKvAl0YEnFM8OCfRZ9lEza4vpxDIAadngBW7Xm5aNZflS~PA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Estimated Numbers of Melanoma Cases and Deaths From 2020 to 2040, by Projection Scenario" class="content-img lazy" path-from-xml="doi220006f3" /></a></div></div><div class="figure-caption clip-last-child"><p class="para">Figure 3 shows different possible scenarios for future changes in the numbers of melanoma cases and deaths. The baseline scenario (black line) assumes no changes in incidence rates, which means that the increase in numbers is solely a result of changes in population size and composition. Because stable incidence rates are not very likely, additional scenarios are presented that give insight into how, for example, reductions in incidence and mortality rates would affect the future absolute burden. The graph also shows that incidence rates would need to decrease by more than 2% in order to keep the number of cases stable or to see decreases (when comparing 2020 and 2040).</p></div></div> </div> <div class="widget-ArticleFiguresAndTables widget-instance-AMA_Article_Tables_Tab"> <div class="figure-table-wrapper thm-bd-top"><div class="table-label">Table. Melanoma Incidence and Mortality in 2020 by Sex, World Region, and HDI Level</div><a class="figure-table-anchor" id="doi220006t1"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="doi220006t1" href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006t1_1652203168.58538.png?Expires=1735230590&Signature=RVeNw7bWY2A-6cr8QiTTZB8xokUhAMAowqngDyhl--ZJFgihjXW~SoqNYwRW1sH3H7H13Qo6l-vviO2-EUtgPcC2YwBeQwCaXsm0-LA9CpjEKQaRGv2xY29UHSLP2T4nCc4vOAs7xQY88ciZ5nIUjbVTcOOwscPk-BZ3C~jQzXAdsAvX1aCamtPsp1naobGomMRJKE-Rfaejm0GxM6wsHJ6FbpXOU8BdXRWBDEkSeBRZOlH8Jn2WKuAYj5IaMF6tL5PBpzILCn0A9MDm6~Ssn5knY1GfGxnxe4ixW5UOaMwWd9eUleQdNUUC9q0O16~W36A46Uh1ASY6YgaIo-R7Aw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="doi220006t1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006t1_1652203168.58538.png?Expires=1735230590&Signature=RVeNw7bWY2A-6cr8QiTTZB8xokUhAMAowqngDyhl--ZJFgihjXW~SoqNYwRW1sH3H7H13Qo6l-vviO2-EUtgPcC2YwBeQwCaXsm0-LA9CpjEKQaRGv2xY29UHSLP2T4nCc4vOAs7xQY88ciZ5nIUjbVTcOOwscPk-BZ3C~jQzXAdsAvX1aCamtPsp1naobGomMRJKE-Rfaejm0GxM6wsHJ6FbpXOU8BdXRWBDEkSeBRZOlH8Jn2WKuAYj5IaMF6tL5PBpzILCn0A9MDm6~Ssn5knY1GfGxnxe4ixW5UOaMwWd9eUleQdNUUC9q0O16~W36A46Uh1ASY6YgaIo-R7Aw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248411646&ar=2790344&imagename=&siteId=12" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006t1_1652203168.58538.png?Expires=1735230590&Signature=RVeNw7bWY2A-6cr8QiTTZB8xokUhAMAowqngDyhl--ZJFgihjXW~SoqNYwRW1sH3H7H13Qo6l-vviO2-EUtgPcC2YwBeQwCaXsm0-LA9CpjEKQaRGv2xY29UHSLP2T4nCc4vOAs7xQY88ciZ5nIUjbVTcOOwscPk-BZ3C~jQzXAdsAvX1aCamtPsp1naobGomMRJKE-Rfaejm0GxM6wsHJ6FbpXOU8BdXRWBDEkSeBRZOlH8Jn2WKuAYj5IaMF6tL5PBpzILCn0A9MDm6~Ssn5knY1GfGxnxe4ixW5UOaMwWd9eUleQdNUUC9q0O16~W36A46Uh1ASY6YgaIo-R7Aw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="doi220006t1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/m_doi220006t1_1652203168.58538.png?Expires=1735230590&Signature=2H7~QtaotPbqKiNsyj6HsP~NK93ujoqTtNU3GPVf7Kn2qaTb2ZeeHBJyU1wtobZ7jXP~QisdXR3uPebtjHbrf2EKPufjN0P18GrWRArJXD5VRzzu3OrduCBbP3FLvhcdRsS9pAUrVF6GN9MioIwGIg0lZkiV1~ZvhXjsDfVA~Ig5HKtX1OMt87u16SHt5JNLUexqik3ORRpfvO4K00ZPOryukfduHx8TR-ezmxxi~oOoYNeAw5O~gyERvD-fyu0lYnKR2rKfIG2Qbawt5pR7Pi7NDEXU-RCjNNHI6rq2zjdeQqsvoC7vUvicG-A4zjXi-MVMXiYrCztRRBobXKri4g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Melanoma Incidence and Mortality in 2020 by Sex, World Region, and HDI Level" class="content-img lazy" path-from-xml="doi220006t1" /></a></div></div><div class="table-caption"></div></div> </div> </div> <div id="multimedia-tab" class="resource-tab js-resource-tab multimedia-tab need-jobs-ad"> </div> <div id="supplemental-tab" class="resource-tab js-resource-tab supplemental-tab need-jobs-ad"> <div class="widget-ArticleDataSupplements widget-instance-AMA_Data_Supplements_Tab"> <div class="supplement"> <a id="note-DOI220006-1" href="https://cdn.jamanetwork.com/ama/content_public/journal/derm/938911/doi220006supp1_prod_1652203168.46038.pdf?Expires=1735423615&Signature=aALMrG7bfzRbeneDC6GsSuxmkkVsqYO57IUFSnycKo4vUQ0wKZyetSGp19i2nE8904nHVUbgQ2PvdanjB75bKek5qN-7iaBYFPbeatt9ieHsilLIkzGhGqyrpF3vRNr3eW-lC-yWiSCb2bITpdFaNhZ1SThh-XynufxR1LJI7U~QnwUyZ5Fvc~YmZm9Qd1jlq2McmEUVmtZJN40B3I7iTb0i7IMr~COmRnfZknd5~WC6tFYdYwoOxx9Iyruo5Xmwrs6AsoviGdLIPP74Ucsnhpu5iidYMtfO5dOZFNOSOCr4A6sSrE5K5mQmSZCNEKf-2gntSW8SHAbgMmLhSvhJxw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" class="supplement-link supplement-download stats-supplement-download" rel="nofollow"> <div class="pdf supplement-type"></div> <div class="supplement-title"><span class="title-label">Supplement.</span><p class="para"><strong>eFigure 1.</strong> Age-Standardized Melanoma Incidence Rates by World Region, Females</p><p class="para"><strong>eFigure 2.</strong> Age-Standardized Melanoma Incidence Rates by World Region, Males</p><p class="para"><strong>eFigure 3.</strong> Age-Standardized Melanoma Mortality Rates by World Region, Females</p><p class="para"><strong>eFigure 4.</strong> Age-Standardized Melanoma Mortality Rates by World Region, Males</p></div> </a> </div> </div> </div> <div id="references-tab" class="resource-tab js-resource-tab references-tab need-jobs-ad"> <div class="references-wrap"> <div class="widget-SectionDisplay widget-instance-AMA_References_Tab"> <div class="references"><div class="reference"><a class="reference-number" id="doi220006r1">1.</a><div class="reference-content">Erdmann F, Lortet-Tieulent J, Schüz J, et al. International trends in the incidence of malignant melanoma 1953-2008—are recent generations at higher or lower risk? <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2013;132(2):385-400. doi:<a href="http://dx.doi.org/10.1002/ijc.27616">10.1002/ijc.27616</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22532371" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=International%20trends%20in%20the%20incidence%20of%20malignant%20melanoma%201953-2008%E2%80%94are%20recent%20generations%20at%20higher%20or%20lower%20risk%3F&author=F%20Erdmann&author=J%20Lortet-Tieulent&author=J%20Schüz&publication_year=2013&journal=Int%20J%20Cancer&volume=132&pages=385-400" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.27616" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.27616" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r2">2.</a><div class="reference-content">Arnold M, Holterhues C, Hollestein LM, et al. Trends in incidence and predictions of cutaneous melanoma across Europe up to 2015. <i xmlns:helper="urn:XsltStringHelper"> J Eur Acad Dermatol Venereol</i>. 2014;28(9):1170-1178. doi:<a href="http://dx.doi.org/10.1111/jdv.12236">10.1111/jdv.12236</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/23962170" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20incidence%20and%20predictions%20of%20cutaneous%20melanoma%20across%20Europe%20up%20to%202015.&author=M%20Arnold&author=C%20Holterhues&author=LM%20Hollestein&publication_year=2014&journal=J%20Eur%20Acad%20Dermatol%20Venereol&volume=28&pages=1170-1178" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/jdv.12236" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1111/jdv.12236" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r3">3.</a><div class="reference-content">El Ghissassi F, Baan R, Straif K, et al; WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens—part D: radiation. <i xmlns:helper="urn:XsltStringHelper"> Lancet Oncol</i>. 2009;10(8):751-752. doi:<a href="http://dx.doi.org/10.1016/S1470-2045(09)70213-X">10.1016/S1470-2045(09)70213-X</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19655431" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20review%20of%20human%20carcinogens%E2%80%94part%20D%3A%20radiation.&author=F%20El Ghissassi&author=R%20Baan&author=K%20Straif&publication_year=2009&journal=Lancet%20Oncol&volume=10&pages=751-752" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S1470-2045(09)70213-X" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S1470-2045(09)70213-X" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r4">4.</a><div class="reference-content">International Agency for Research on Cancer. <i>Radiation: Volume 100 D: A Review of Human Carcinogens: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans</i>. IARC Publications; 2012.</div></div><div class="reference"><a class="reference-number" id="doi220006r5">5.</a><div class="reference-content">Arnold M, de Vries E, Whiteman DC, et al. Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2018;143(6):1305-1314. doi:<a href="http://dx.doi.org/10.1002/ijc.31527">10.1002/ijc.31527</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29659012" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Global%20burden%20of%20cutaneous%20melanoma%20attributable%20to%20ultraviolet%20radiation%20in%202012.&author=M%20Arnold&author=E%20de Vries&author=DC%20Whiteman&publication_year=2018&journal=Int%20J%20Cancer&volume=143&pages=1305-1314" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v143.6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v143.6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r6">6.</a><div class="reference-content">Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. <i xmlns:helper="urn:XsltStringHelper"> Lancet Oncol</i>. 2017;18(12):1579-1589. doi:<a href="http://dx.doi.org/10.1016/S1470-2045(17)30677-0">10.1016/S1470-2045(17)30677-0</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29111259" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20incidence%20and%20mortality%20among%20young%20adults%20aged%2020-39%20years%20worldwide%20in%202012%3A%20a%20population-based%20study.&author=MM%20Fidler&author=S%20Gupta&author=I%20Soerjomataram&author=J%20Ferlay&author=E%20Steliarova-Foucher&author=F%20Bray&publication_year=2017&journal=Lancet%20Oncol&volume=18&pages=1579-1589" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S1470-2045(17)30677-0" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S1470-2045(17)30677-0" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r7">7.</a><div class="reference-content">Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. <i xmlns:helper="urn:XsltStringHelper"> J Invest Dermatol</i>. 2016;136(6):1161-1171. doi:<a href="http://dx.doi.org/10.1016/j.jid.2016.01.035">10.1016/j.jid.2016.01.035</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26902923" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20growing%20burden%20of%20invasive%20melanoma%3A%20projections%20of%20incidence%20rates%20and%20numbers%20of%20new%20cases%20in%20six%20susceptible%20populations%20through%202031.&author=DC%20Whiteman&author=AC%20Green&author=CM%20Olsen&publication_year=2016&journal=J%20Invest%20Dermatol&volume=136&pages=1161-1171" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jid.2016.01.035" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.jid.2016.01.035" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r8">8.</a><div class="reference-content">Garbe C, Keim U, Gandini S, et al. Epidemiology of cutaneous melanoma and keratinocyte cancer in white populations 1943-2036. <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2021;152:18-25. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2021.04.029">10.1016/j.ejca.2021.04.029</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34062483" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Epidemiology%20of%20cutaneous%20melanoma%20and%20keratinocyte%20cancer%20in%20white%20populations%201943-2036.&author=C%20Garbe&author=U%20Keim&author=S%20Gandini&publication_year=2021&journal=Eur%20J%20Cancer&volume=152&pages=18-25" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2021.04.029" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2021.04.029" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r9">9.</a><div class="reference-content">Paulson KG, Gupta D, Kim TS, et al. Age-specific incidence of melanoma in the United States. <i xmlns:helper="urn:XsltStringHelper"> JAMA Dermatol</i>. 2020;156(1):57-64. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2019.3353">10.1001/jamadermatol.2019.3353</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31721989" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Age-specific%20incidence%20of%20melanoma%20in%20the%20United%20States.&author=KG%20Paulson&author=D%20Gupta&author=TS%20Kim&publication_year=2020&journal=JAMA%20Dermatol&volume=156&pages=57-64" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamadermatol.2019.3353" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jamadermatol.2019.3353" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r10">10.</a><div class="reference-content">Baade PD, Whiteman DC, Janda M, et al. Long-term deaths from melanoma according to tumor thickness at diagnosis. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2020;147(5):1391-1396. doi:<a href="http://dx.doi.org/10.1002/ijc.32930">10.1002/ijc.32930</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32067220" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Long-term%20deaths%20from%20melanoma%20according%20to%20tumor%20thickness%20at%20diagnosis.&author=PD%20Baade&author=DC%20Whiteman&author=M%20Janda&publication_year=2020&journal=Int%20J%20Cancer&volume=147&pages=1391-1396" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v147.5" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v147.5" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r11">11.</a><div class="reference-content">Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: an overview. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2021. doi:<a href="http://dx.doi.org/10.1002/ijc.33588">10.1002/ijc.33588</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33818764" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20statistics%20for%20the%20year%202020%3A%20an%20overview.&author=J%20Ferlay&author=M%20Colombet&author=I%20Soerjomataram&publication_year=2021&journal=Int%20J%20Cancer&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v149.4" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v149.4" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r12">12.</a><div class="reference-content">Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. <i xmlns:helper="urn:XsltStringHelper"> CA Cancer J Clin</i>. 2021;71(3):209-249. doi:<a href="http://dx.doi.org/10.3322/caac.21660">10.3322/caac.21660</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33538338" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Global%20cancer%20statistics%202020%3A%20GLOBOCAN%20estimates%20of%20incidence%20and%20mortality%20worldwide%20for%2036%20cancers%20in%20185%20countries.&author=H%20Sung&author=J%20Ferlay&author=RL%20Siegel&publication_year=2021&journal=CA%20Cancer%20J%20Clin&volume=71&pages=209-249" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3322/caac.v71.3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3322/caac.v71.3" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r13">13.</a><div class="reference-content">International Agency for Research on Cancer: Global Cancer Observatory. Cancer today. Published 2021. Accessed April 28, 2021. <a href="https://gco.iarc.fr/today/home">https://gco.iarc.fr/today/home</a></div></div><div class="reference"><a class="reference-number" id="doi220006r14">14.</a><div class="reference-content">United Nations Statistics Division. Standard country or area codes for statistical use (M49): aggregated. Published 2021. Accessed April 28, 2021.</div></div><div class="reference"><a class="reference-number" id="doi220006r15">15.</a><div class="reference-content">Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2019;144(8):1941-1953. doi:<a href="http://dx.doi.org/10.1002/ijc.31937">10.1002/ijc.31937</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30350310" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimating%20the%20global%20cancer%20incidence%20and%20mortality%20in%202018%3A%20GLOBOCAN%20sources%20and%20methods.&author=J%20Ferlay&author=M%20Colombet&author=I%20Soerjomataram&publication_year=2019&journal=Int%20J%20Cancer&volume=144&pages=1941-1953" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v144.8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v144.8" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r16">16.</a><div class="reference-content">Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2015;136(5):E359-E386. doi:<a href="http://dx.doi.org/10.1002/ijc.29210">10.1002/ijc.29210</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/25220842" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20incidence%20and%20mortality%20worldwide%3A%20sources%2C%20methods%20and%20major%20patterns%20in%20GLOBOCAN%202012.&author=J%20Ferlay&author=I%20Soerjomataram&author=R%20Dikshit&publication_year=2015&journal=Int%20J%20Cancer&volume=136&pages=E359-E386" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.29210" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.29210" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r17">17.</a><div class="reference-content">Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2010;127(12):2893-2917. doi:<a href="http://dx.doi.org/10.1002/ijc.25516">10.1002/ijc.25516</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21351269" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimates%20of%20worldwide%20burden%20of%20cancer%20in%202008%3A%20GLOBOCAN%202008.&author=J%20Ferlay&author=HR%20Shin&author=F%20Bray&author=D%20Forman&author=C%20Mathers&author=DM%20Parkin&publication_year=2010&journal=Int%20J%20Cancer&volume=127&pages=2893-2917" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v127:12" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v127:12" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r18">18.</a><div class="reference-content">Segi M, Kurihara M. <i xmlns:helper="urn:XsltStringHelper"> Cancer Mortality for Selected Sites in 24 Countries (1950-1957)</i>. 2nd ed. Tohoku University of Medicine; 1960.</div></div><div class="reference"><a class="reference-number" id="doi220006r19">19.</a><div class="reference-content">Doll R, Payne P, Waterhouse J, eds. <i xmlns:helper="urn:XsltStringHelper"> Cancer Incidence in Five Continents: A Technical Report</i>. Springer; 1966. doi:<a href="http://dx.doi.org/10.1007/978-3-642-85849-9">10.1007/978-3-642-85849-9</a></div></div><div class="reference"><a class="reference-number" id="doi220006r20">20.</a><div class="reference-content">Day NE. Cancer incidence in five continents. cumulative rate and cumulative risk. <i xmlns:helper="urn:XsltStringHelper"> IARC Sci Publ</i>. 1992;(120):862-864.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/1284607" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20incidence%20in%20five%20continents.%20cumulative%20rate%20and%20cumulative%20risk.&author=NE%20Day&publication_year=1992&journal=IARC%20Sci%20Publ&volume=&pages=862-864" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a></div></div><div class="reference"><a class="reference-number" id="doi220006r21">21.</a><div class="reference-content">United Nations Development Programme. <i xmlns:helper="urn:XsltStringHelper"> Human Development Report 2020</i>. United Nations; 2020.</div></div><div class="reference"><a class="reference-number" id="doi220006r22">22.</a><div class="reference-content">Dulskas A, Cerkauskaite D, Vincerževskiene I, Urbonas V. Trends in incidence and mortality of skin melanoma in Lithuania 1991-2015. <i xmlns:helper="urn:XsltStringHelper"> Int J Environ Res Public Health</i>. 2021;18(8):4165. doi:<a href="http://dx.doi.org/10.3390/ijerph18084165">10.3390/ijerph18084165</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33920754" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20incidence%20and%20mortality%20of%20skin%20melanoma%20in%20Lithuania%201991-2015.&author=A%20Dulskas&author=D%20Cerkauskaite&author=I%20Vincerževskiene&author=V%20Urbonas&publication_year=2021&journal=Int%20J%20Environ%20Res%20Public%20Health&volume=18&pages=4165" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3390/ijerph18084165" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3390/ijerph18084165" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r23">23.</a><div class="reference-content">Olsen CM, Wilson LF, Green AC, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. <i xmlns:helper="urn:XsltStringHelper"> Aust N Z J Public Health</i>. 2015;39(5):471-476. doi:<a href="http://dx.doi.org/10.1111/1753-6405.12470">10.1111/1753-6405.12470</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26437734" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancers%20in%20Australia%20attributable%20to%20exposure%20to%20solar%20ultraviolet%20radiation%20and%20prevented%20by%20regular%20sunscreen%20use.&author=CM%20Olsen&author=LF%20Wilson&author=AC%20Green&publication_year=2015&journal=Aust%20N%20Z%20J%20Public%20Health&volume=39&pages=471-476" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/1753-6405.12470" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1111/1753-6405.12470" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r24">24.</a><div class="reference-content">Armstrong BK, Kricker A. How much melanoma is caused by sun exposure? <i xmlns:helper="urn:XsltStringHelper"> Melanoma Res</i>. 1993;3(6):395-401. doi:<a href="http://dx.doi.org/10.1097/00008390-199311000-00002">10.1097/00008390-199311000-00002</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8161879" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=How%20much%20melanoma%20is%20caused%20by%20sun%20exposure%3F&author=BK%20Armstrong&author=A%20Kricker&publication_year=1993&journal=Melanoma%20Res&volume=3&pages=395-401" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00008390-199311000-00002" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00008390-199311000-00002" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r25">25.</a><div class="reference-content">Iannacone MR, Green AC. Towards skin cancer prevention and early detection: evolution of skin cancer awareness campaigns in Australia. <i xmlns:helper="urn:XsltStringHelper"> Melanoma Manag</i>. 2014;1(1):75-84. doi:<a href="http://dx.doi.org/10.2217/mmt.14.6">10.2217/mmt.14.6</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30190812" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Towards%20skin%20cancer%20prevention%20and%20early%20detection%3A%20evolution%20of%20skin%20cancer%20awareness%20campaigns%20in%20Australia.&author=MR%20Iannacone&author=AC%20Green&publication_year=2014&journal=Melanoma%20Manag&volume=1&pages=75-84" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.2217/mmt.14.6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.2217/mmt.14.6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r26">26.</a><div class="reference-content">de Vries E, Sierra M, Piñeros M, Loria D, Forman D. The burden of cutaneous melanoma and status of preventive measures in Central and South America. <i xmlns:helper="urn:XsltStringHelper"> Cancer Epidemiol</i>. 2016;44(suppl 1):S100-S109. doi:<a href="http://dx.doi.org/10.1016/j.canep.2016.02.005">10.1016/j.canep.2016.02.005</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27034057" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20burden%20of%20cutaneous%20melanoma%20and%20status%20of%20preventive%20measures%20in%20Central%20and%20South%20America.&author=E%20de Vries&author=M%20Sierra&author=M%20Piñeros&author=D%20Loria&author=D%20Forman&publication_year=2016&journal=Cancer%20Epidemiol&volume=44&pages=S100-S109" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.canep.2016.02.005" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.canep.2016.02.005" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r27">27.</a><div class="reference-content">Purdue MP, From L, Armstrong BK, et al; Genes, Environment, and Melanoma Study Group. Etiologic and other factors predicting nevus-associated cutaneous malignant melanoma. <i xmlns:helper="urn:XsltStringHelper"> Cancer Epidemiol Biomarkers Prev</i>. 2005;14(8):2015-2022. doi:<a href="http://dx.doi.org/10.1158/1055-9965.EPI-05-0097">10.1158/1055-9965.EPI-05-0097</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16103454" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Etiologic%20and%20other%20factors%20predicting%20nevus-associated%20cutaneous%20malignant%20melanoma.&author=MP%20Purdue&author=L%20From&author=BK%20Armstrong&publication_year=2005&journal=Cancer%20Epidemiol%20Biomarkers%20Prev&volume=14&pages=2015-2022" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1158/1055-9965.EPI-05-0097" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1158/1055-9965.EPI-05-0097" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r28">28.</a><div class="reference-content">Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma. III: family history, actinic damage and phenotypic factors. <i>Eur J Cancer</i>. 2005;41(14):2040-2059.</div></div><div class="reference"><a class="reference-number" id="doi220006r29">29.</a><div class="reference-content">Landi MT, Bishop DT, MacGregor S, et al; GenoMEL Consortium; Q-MEGA and QTWIN Investigators; ATHENS Melanoma Study Group; 23andMe; SDH Study Group; IBD Investigators; Essen-Heidelberg Investigators; AMFS Investigators; MelaNostrum Consortium. Genome-wide association meta-analyses combining multiple risk phenotypes provide insights into the genetic architecture of cutaneous melanoma susceptibility. <i xmlns:helper="urn:XsltStringHelper"> Nat Genet</i>. 2020;52(5):494-504. doi:<a href="http://dx.doi.org/10.1038/s41588-020-0611-8">10.1038/s41588-020-0611-8</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32341527" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Genome-wide%20association%20meta-analyses%20combining%20multiple%20risk%20phenotypes%20provide%20insights%20into%20the%20genetic%20architecture%20of%20cutaneous%20melanoma%20susceptibility.&author=MT%20Landi&author=DT%20Bishop&author=S%20MacGregor&publication_year=2020&journal=Nat%20Genet&volume=52&pages=494-504" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/s41588-020-0611-8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/s41588-020-0611-8" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r30">30.</a><div class="reference-content">Goldstein AM, Chan M, Harland M, et al; Melanoma Genetics Consortium (GenoMEL). High-risk melanoma susceptibility genes and pancreatic cancer, neural system tumors, and uveal melanoma across GenoMEL. <i xmlns:helper="urn:XsltStringHelper"> Cancer Res</i>. 2006;66(20):9818-9828. doi:<a href="http://dx.doi.org/10.1158/0008-5472.CAN-06-0494">10.1158/0008-5472.CAN-06-0494</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17047042" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=High-risk%20melanoma%20susceptibility%20genes%20and%20pancreatic%20cancer%2C%20neural%20system%20tumors%2C%20and%20uveal%20melanoma%20across%20GenoMEL.&author=AM%20Goldstein&author=M%20Chan&author=M%20Harland&publication_year=2006&journal=Cancer%20Res&volume=66&pages=9818-9828" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1158/0008-5472.CAN-06-0494" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1158/0008-5472.CAN-06-0494" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r31">31.</a><div class="reference-content">Zuo L, Weger J, Yang Q, et al. Germline mutations in the p16INK4a binding domain of CDK4 in familial melanoma. <i xmlns:helper="urn:XsltStringHelper"> Nat Genet</i>. 1996;12(1):97-99. doi:<a href="http://dx.doi.org/10.1038/ng0196-97">10.1038/ng0196-97</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8528263" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Germline%20mutations%20in%20the%20p16INK4a%20binding%20domain%20of%20CDK4%20in%20familial%20melanoma.&author=L%20Zuo&author=J%20Weger&author=Q%20Yang&publication_year=1996&journal=Nat%20Genet&volume=12&pages=97-99" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/ng0196-97" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/ng0196-97" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r32">32.</a><div class="reference-content">Valverde P, Healy E, Jackson I, Rees JL, Thody AJ. Variants of the melanocyte-stimulating hormone receptor gene are associated with red hair and fair skin in humans. <i xmlns:helper="urn:XsltStringHelper"> Nat Genet</i>. 1995;11(3):328-330. doi:<a href="http://dx.doi.org/10.1038/ng1195-328">10.1038/ng1195-328</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/7581459" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Variants%20of%20the%20melanocyte-stimulating%20hormone%20receptor%20gene%20are%20associated%20with%20red%20hair%20and%20fair%20skin%20in%20humans.&author=P%20Valverde&author=E%20Healy&author=I%20Jackson&author=JL%20Rees&author=AJ%20Thody&publication_year=1995&journal=Nat%20Genet&volume=11&pages=328-330" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/ng1195-328" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/ng1195-328" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r33">33.</a><div class="reference-content">Olsen CM, Thompson JF, Pandeya N, Whiteman DC. Evaluation of sex-specific incidence of melanoma. <i xmlns:helper="urn:XsltStringHelper"> JAMA Dermatol</i>. 2020;156(5):553-560. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2020.0470">10.1001/jamadermatol.2020.0470</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32211827" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Evaluation%20of%20sex-specific%20incidence%20of%20melanoma.&author=CM%20Olsen&author=JF%20Thompson&author=N%20Pandeya&author=DC%20Whiteman&publication_year=2020&journal=JAMA%20Dermatol&volume=156&pages=553-560" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamadermatol.2020.0470" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jamadermatol.2020.0470" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r34">34.</a><div class="reference-content">Bellenghi M, Puglisi R, Pontecorvi G, De Feo A, Carè A, Mattia G. Sex and gender disparities in melanoma. <i xmlns:helper="urn:XsltStringHelper"> Cancers (Basel)</i>. 2020;12(7):E1819. doi:<a href="http://dx.doi.org/10.3390/cancers12071819">10.3390/cancers12071819</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32645881" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Sex%20and%20gender%20disparities%20in%20melanoma.&author=M%20Bellenghi&author=R%20Puglisi&author=G%20Pontecorvi&author=A%20De Feo&author=A%20Carè&author=G%20Mattia&publication_year=2020&journal=Cancers%20%28Basel%29&volume=12&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3390/cancers12071819" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3390/cancers12071819" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r35">35.</a><div class="reference-content">Sung H, Siegel RL, Rosenberg PS, Jemal A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. <i xmlns:helper="urn:XsltStringHelper"> Lancet Public Health</i>. 2019;4(3):e137-e147. doi:<a href="http://dx.doi.org/10.1016/S2468-2667(18)30267-6">10.1016/S2468-2667(18)30267-6</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30733056" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Emerging%20cancer%20trends%20among%20young%20adults%20in%20the%20USA%3A%20analysis%20of%20a%20population-based%20cancer%20registry.&author=H%20Sung&author=RL%20Siegel&author=PS%20Rosenberg&author=A%20Jemal&publication_year=2019&journal=Lancet%20Public%20Health&volume=4&pages=e137-e147" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2468-2667(18)30267-6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S2468-2667(18)30267-6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r36">36.</a><div class="reference-content">MacKie RM, Bray C, Vestey J, et al; Scottish Melanoma Group. Melanoma incidence and mortality in Scotland 1979-2003. <i xmlns:helper="urn:XsltStringHelper"> Br J Cancer</i>. 2007;96(11):1772-1777. doi:<a href="http://dx.doi.org/10.1038/sj.bjc.6603801">10.1038/sj.bjc.6603801</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17533392" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Melanoma%20incidence%20and%20mortality%20in%20Scotland%201979-2003.&author=RM%20MacKie&author=C%20Bray&author=J%20Vestey&publication_year=2007&journal=Br%20J%20Cancer&volume=96&pages=1772-1777" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/sj.bjc.6603801" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/sj.bjc.6603801" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r37">37.</a><div class="reference-content">Glazer AM, Winkelmann RR, Farberg AS, Rigel DS. Analysis of trends in US melanoma incidence and mortality. <i xmlns:helper="urn:XsltStringHelper"> JAMA Dermatol</i>. 2017;153(2)225-226. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2016.4512">10.1001/jamadermatol.2016.4512</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/28002545" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Analysis%20of%20trends%20in%20US%20melanoma%20incidence%20and%20mortality.&author=AM%20Glazer&author=RR%20Winkelmann&author=AS%20Farberg&author=DS%20Rigel&publication_year=2017&journal=JAMA%20Dermatol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamadermatol.2016.4512" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jamadermatol.2016.4512" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r38">38.</a><div class="reference-content">Lindholm C, Andersson R, Dufmats M, et al; Swedish Melanoma Study Group. Invasive cutaneous malignant melanoma in Sweden, 1990-1999: a prospective, population-based study of survival and prognostic factors. <i xmlns:helper="urn:XsltStringHelper"> Cancer</i>. 2004;101(9):2067-2078. doi:<a href="http://dx.doi.org/10.1002/cncr.20602">10.1002/cncr.20602</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15372475" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Invasive%20cutaneous%20malignant%20melanoma%20in%20Sweden%2C%201990-1999%3A%20a%20prospective%2C%20population-based%20study%20of%20survival%20and%20prognostic%20factors.&author=C%20Lindholm&author=R%20Andersson&author=M%20Dufmats&publication_year=2004&journal=Cancer&volume=101&pages=2067-2078" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/cncr.v101:9" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/cncr.v101:9" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r39">39.</a><div class="reference-content">de Vries E, Coebergh JW. Cutaneous malignant melanoma in Europe. <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2004;40(16):2355-2366. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2004.06.003">10.1016/j.ejca.2004.06.003</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15519506" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cutaneous%20malignant%20melanoma%20in%20Europe.&author=E%20de Vries&author=JW%20Coebergh&publication_year=2004&journal=Eur%20J%20Cancer&volume=40&pages=2355-2366" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2004.06.003" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2004.06.003" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r40">40.</a><div class="reference-content">Allemani C, Matsuda T, Di Carlo V, et al; CONCORD Working Group. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. <i xmlns:helper="urn:XsltStringHelper"> Lancet</i>. 2018;391(10125):1023-1075. doi:<a href="http://dx.doi.org/10.1016/S0140-6736(17)33326-3">10.1016/S0140-6736(17)33326-3</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29395269" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Global%20surveillance%20of%20trends%20in%20cancer%20survival%202000-14%20%28CONCORD-3%29%3A%20analysis%20of%20individual%20records%20for%2037%E2%80%AF513%E2%80%AF025%20patients%20diagnosed%20with%20one%20of%2018%20cancers%20from%20322%20population-based%20registries%20in%2071%20countries.&author=C%20Allemani&author=T%20Matsuda&author=V%20Di Carlo&publication_year=2018&journal=Lancet&volume=391&pages=1023-1075" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S0140-6736(17)33326-3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S0140-6736(17)33326-3" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r41">41.</a><div class="reference-content">Sacchetto L, Zanetti R, Comber H, et al. Trends in incidence of thick, thin and in situ melanoma in Europe. <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2018;92:108-118. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2017.12.024">10.1016/j.ejca.2017.12.024</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29395684" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20incidence%20of%20thick%2C%20thin%20and%20in%20situ%20melanoma%20in%20Europe.&author=L%20Sacchetto&author=R%20Zanetti&author=H%20Comber&publication_year=2018&journal=Eur%20J%20Cancer&volume=92&pages=108-118" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2017.12.024" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2017.12.024" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r42">42.</a><div class="reference-content">Sankaranarayanan R, Swaminathan R, eds. <i xmlns:helper="urn:XsltStringHelper"> Cancer Survival in Africa, Asia, the Caribbean and Central America</i>. International Agency for Research on Cancer/World Health Organization; 2011.</div></div><div class="reference"><a class="reference-number" id="doi220006r43">43.</a><div class="reference-content">Berk-Krauss J, Stein JA, Weber J, Polsky D, Geller AC. New systematic therapies and trends in cutaneous melanoma deaths among US whites, 1986-2016. <i xmlns:helper="urn:XsltStringHelper"> Am J Public Health</i>. 2020;110(5):731-733. doi:<a href="http://dx.doi.org/10.2105/AJPH.2020.305567">10.2105/AJPH.2020.305567</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32191523" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=New%20systematic%20therapies%20and%20trends%20in%20cutaneous%20melanoma%20deaths%20among%20US%20whites%2C%201986-2016.&author=J%20Berk-Krauss&author=JA%20Stein&author=J%20Weber&author=D%20Polsky&author=AC%20Geller&publication_year=2020&journal=Am%20J%20Public%20Health&volume=110&pages=731-733" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.2105/AJPH.2020.305567" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.2105/AJPH.2020.305567" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r44">44.</a><div class="reference-content">Mason R, Au L, Ingles Garces A, Larkin J. Current and emerging systemic therapies for cutaneous metastatic melanoma. <i xmlns:helper="urn:XsltStringHelper"> Expert Opin Pharmacother</i>. 2019;20(9):1135-1152. doi:<a href="http://dx.doi.org/10.1080/14656566.2019.1601700">10.1080/14656566.2019.1601700</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31025594" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Current%20and%20emerging%20systemic%20therapies%20for%20cutaneous%20metastatic%20melanoma.&author=R%20Mason&author=L%20Au&author=A%20Ingles Garces&author=J%20Larkin&publication_year=2019&journal=Expert%20Opin%20Pharmacother&volume=20&pages=1135-1152" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1080/14656566.2019.1601700" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1080/14656566.2019.1601700" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r45">45.</a><div class="reference-content">Whiteman DC, Baade PD, Olsen CM. More people die from thin melanomas (≤1 mm) than from thick melanomas (>4 mm) in Queensland, Australia. <i xmlns:helper="urn:XsltStringHelper"> J Invest Dermatol</i>. 2015;135(4):1190-1193. doi:<a href="http://dx.doi.org/10.1038/jid.2014.452">10.1038/jid.2014.452</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/25330295" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=More%20people%20die%20from%20thin%20melanomas%20%28%E2%89%A41%E2%80%89mm%29%20than%20from%20thick%20melanomas%20%28%3E4%E2%80%89mm%29%20in%20Queensland%2C%20Australia.&author=DC%20Whiteman&author=PD%20Baade&author=CM%20Olsen&publication_year=2015&journal=J%20Invest%20Dermatol&volume=135&pages=1190-1193" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/jid.2014.452" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/jid.2014.452" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r46">46.</a><div class="reference-content">Baade P, Meng X, Youlden D, Aitken J, Youl P. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990-2006. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2012;130(1):170-178. doi:<a href="http://dx.doi.org/10.1002/ijc.25996">10.1002/ijc.25996</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21344376" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Time%20trends%20and%20latitudinal%20differences%20in%20melanoma%20thickness%20distribution%20in%20Australia%2C%201990-2006.&author=P%20Baade&author=X%20Meng&author=D%20Youlden&author=J%20Aitken&author=P%20Youl&publication_year=2012&journal=Int%20J%20Cancer&volume=130&pages=170-178" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.25996" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.25996" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r47">47.</a><div class="reference-content">van der Leest RJ, Zoutendijk J, Nijsten T, et al. Increasing time trends of thin melanomas in The Netherlands: what are the explanations of recent accelerations? <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2015;51(18):2833-2841. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2015.09.008">10.1016/j.ejca.2015.09.008</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26589973" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Increasing%20time%20trends%20of%20thin%20melanomas%20in%20The%20Netherlands%3A%20what%20are%20the%20explanations%20of%20recent%20accelerations%3F&author=RJ%20van der Leest&author=J%20Zoutendijk&author=T%20Nijsten&publication_year=2015&journal=Eur%20J%20Cancer&volume=51&pages=2833-2841" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2015.09.008" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2015.09.008" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r48">48.</a><div class="reference-content">Watson M, Geller AC, Tucker MA, Guy GP Jr, Weinstock MA. Melanoma burden and recent trends among non-Hispanic whites aged 15-49 years, United States. <i xmlns:helper="urn:XsltStringHelper"> Prev Med</i>. 2016;91:294-298. doi:<a href="http://dx.doi.org/10.1016/j.ypmed.2016.08.032">10.1016/j.ypmed.2016.08.032</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27565055" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Melanoma%20burden%20and%20recent%20trends%20among%20non-Hispanic%20whites%20aged%2015-49%20years%2C%20United%20States.&author=M%20Watson&author=AC%20Geller&author=MA%20Tucker&author=GP%20Guy&author=MA%20Weinstock&publication_year=2016&journal=Prev%20Med&volume=91&pages=294-298" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ypmed.2016.08.032" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ypmed.2016.08.032" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r49">49.</a><div class="reference-content">Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. <i xmlns:helper="urn:XsltStringHelper"> CA Cancer J Clin</i>. 2016;66(1):7-30. doi:<a href="http://dx.doi.org/10.3322/caac.21332">10.3322/caac.21332</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26742998" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20statistics%2C%202016.&author=RL%20Siegel&author=KD%20Miller&author=A%20Jemal&publication_year=2016&journal=CA%20Cancer%20J%20Clin&volume=66&pages=7-30" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3322/caac.21332" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3322/caac.21332" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r50">50.</a><div class="reference-content">Welch HG, Mazer BL, Adamson AS. The rapid rise in cutaneous melanoma diagnoses. <i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2021;384(1):72-79. doi:<a href="http://dx.doi.org/10.1056/NEJMsb2019760">10.1056/NEJMsb2019760</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33406334" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20rapid%20rise%20in%20cutaneous%20melanoma%20diagnoses.&author=HG%20Welch&author=BL%20Mazer&author=AS%20Adamson&publication_year=2021&journal=N%20Engl%20J%20Med&volume=384&pages=72-79" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMsb2019760" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1056/NEJMsb2019760" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r51">51.</a><div class="reference-content">Waldmann A, Nolte S, Weinstock MA, et al. Skin cancer screening participation and impact on melanoma incidence in Germany—an observational study on incidence trends in regions with and without population-based screening. <i xmlns:helper="urn:XsltStringHelper"> Br J Cancer</i>. 2012;106(5):970-974. doi:<a href="http://dx.doi.org/10.1038/bjc.2012.22">10.1038/bjc.2012.22</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22294187" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Skin%20cancer%20screening%20participation%20and%20impact%20on%20melanoma%20incidence%20in%20Germany%E2%80%94an%20observational%20study%20on%20incidence%20trends%20in%20regions%20with%20and%20without%20population-based%20screening.&author=A%20Waldmann&author=S%20Nolte&author=MA%20Weinstock&publication_year=2012&journal=Br%20J%20Cancer&volume=106&pages=970-974" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/bjc.2012.22" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/bjc.2012.22" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r52">52.</a><div class="reference-content">Brunssen A, Waldmann A, Eisemann N, Katalinic A. Impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence and mortality: a systematic review. <i xmlns:helper="urn:XsltStringHelper"> J Am Acad Dermatol</i>. 2017;76(1):129-139.e10. doi:<a href="http://dx.doi.org/10.1016/j.jaad.2016.07.045">10.1016/j.jaad.2016.07.045</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27707591" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Impact%20of%20skin%20cancer%20screening%20and%20secondary%20prevention%20campaigns%20on%20skin%20cancer%20incidence%20and%20mortality%3A%20a%20systematic%20review.&author=A%20Brunssen&author=A%20Waldmann&author=N%20Eisemann&author=A%20Katalinic&publication_year=2017&journal=J%20Am%20Acad%20Dermatol&volume=76&pages=129-139.e10" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jaad.2016.07.045" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.jaad.2016.07.045" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r53">53.</a><div class="reference-content">Herbert A, Koo MM, Barclay ME, et al. Stage-specific incidence trends of melanoma in an English region, 1996-2015: longitudinal analyses of population-based data. <i xmlns:helper="urn:XsltStringHelper"> Melanoma Res</i>. 2020;30(3):279-285. doi:<a href="http://dx.doi.org/10.1097/CMR.0000000000000489">10.1097/CMR.0000000000000489</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30106842" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Stage-specific%20incidence%20trends%20of%20melanoma%20in%20an%20English%20region%2C%201996-2015%3A%20longitudinal%20analyses%20of%20population-based%20data.&author=A%20Herbert&author=MM%20Koo&author=ME%20Barclay&publication_year=2020&journal=Melanoma%20Res&volume=30&pages=279-285" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/CMR.0000000000000489" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/CMR.0000000000000489" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r54">54.</a><div class="reference-content">Bray F, Guilloux A, Sankila R, Parkin DM. Practical implications of imposing a new world standard population. <i xmlns:helper="urn:XsltStringHelper"> Cancer Causes Control</i>. 2002;13(2):175-182. doi:<a href="http://dx.doi.org/10.1023/A:1014344519276">10.1023/A:1014344519276</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/11936824" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Practical%20implications%20of%20imposing%20a%20new%20world%20standard%20population.&author=F%20Bray&author=A%20Guilloux&author=R%20Sankila&author=DM%20Parkin&publication_year=2002&journal=Cancer%20Causes%20Control&volume=13&pages=175-182" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1023/A:1014344519276" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1023/A:1014344519276" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r55">55.</a><div class="reference-content">Bray F, Møller B. Predicting the future burden of cancer. <i xmlns:helper="urn:XsltStringHelper"> Nat Rev Cancer</i>. 2006;6(1):63-74. doi:<a href="http://dx.doi.org/10.1038/nrc1781">10.1038/nrc1781</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16372017" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Predicting%20the%20future%20burden%20of%20cancer.&author=F%20Bray&author=B%20Møller&publication_year=2006&journal=Nat%20Rev%20Cancer&volume=6&pages=63-74" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/nrc1781" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/nrc1781" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r56">56.</a><div class="reference-content">Khair DO, Bax HJ, Mele S, et al. Combining immune checkpoint inhibitors: established and emerging targets and strategies to improve outcomes in melanoma. <i xmlns:helper="urn:XsltStringHelper"> Front Immunol</i>. 2019;10:453. doi:<a href="http://dx.doi.org/10.3389/fimmu.2019.00453">10.3389/fimmu.2019.00453</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30941125" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Combining%20immune%20checkpoint%20inhibitors%3A%20established%20and%20emerging%20targets%20and%20strategies%20to%20improve%20outcomes%20in%20melanoma.&author=DO%20Khair&author=HJ%20Bax&author=S%20Mele&publication_year=2019&journal=Front%20Immunol&volume=10&pages=453" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3389/fimmu.2019.00453" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3389/fimmu.2019.00453" xmlns:helper="urn:XsltStringHelper"> </span></div></div></div> </div> </div> </div> <div id="related-tab" class="resource-tab js-resource-tab related-tab need-jobs-ad"> <div class="widget-ArticleLinks widget-instance-AMA_See_Also_Related_Content"> <ul class="article-links related-content"> <li class="article-link related-article odd"> <a href="https://jamanetwork.com/journals/jama/fullarticle/2802151" class="td-n"> <div class="related-article-title">Patient Information: Melanoma</div> <div class="related-journal-name">JAMA</div> <div class="related-article-type">JAMA Patient Page</div> <div class="related-article-date">March 21, 2023</div> <div class="related-article-excerpt">This JAMA Patient Page describes melanoma, its risk factors, diagnosis, treatment, and prognosis.</div> <div class="related-article-authors">Jennifer Y. 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data-value="10.1001/jamadermatol.2022.0160" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articleTitle" data-value="Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="type" data-value="Original Investigation" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueVolume" data-value="158" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueNo" data-value="5" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="publishDate" data-value="May 1, 2022" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="topics" data-value="Dermatology, Oncology, Skin Cancer, Cancer Epidemiology, Melanoma" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="topicCode" data-value="5598, 5801, 5906, 38787, 5746" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="category" data-value="Research" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="journalClub" data-value="No" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentStatus" data-value="Free" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articlePubState" data-value="Final" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentMedium" data-value="Article" data-type="string"></span> <div class="meta-article-type-wrap"> <div class="meta-article-type thm-col">Original Investigation </div> </div> <div class="meta-date">March 30, 2022</div> <div class="meta-article-title-wrap"> <h1 class="meta-article-title ">Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040</h1> </div> <div class="meta-authors"> <span class="meta-authors--limited"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Melina+Arnold&q=Melina+Arnold" rel=nofollow target="_blank">Melina Arnold, PhD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Deependra+Singh&q=Deependra+Singh" rel=nofollow target="_blank">Deependra Singh, PhD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Mathieu+Laversanne&q=Mathieu+Laversanne" rel=nofollow target="_blank">Mathieu Laversanne, MSc<sup>1</sup></a></span>; <a class="meta-authors--etal td-u stats-meta-authors--etal">et al</a></span> <span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jerome+Vignat&q=Jerome+Vignat" rel=nofollow target="_blank">Jerome Vignat, MSc<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Salvatore+Vaccarella&q=Salvatore+Vaccarella" rel=nofollow target="_blank">Salvatore Vaccarella, PhD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Filip+Meheus&q=Filip+Meheus" rel=nofollow target="_blank">Filip Meheus, PhD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Anne+E.+Cust&q=Anne+E.+Cust" rel=nofollow target="_blank">Anne E. Cust, PhD, MPH(Hons)<sup>2,3</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Esther+de+Vries&q=Esther+de+Vries" rel=nofollow target="_blank">Esther de Vries, PhD<sup>4</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=David+C.+Whiteman&q=David+C.+Whiteman" rel=nofollow target="_blank">David C. Whiteman, MBBS(Hons), PhD<sup>5</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Freddie+Bray&q=Freddie+Bray" rel=nofollow target="_blank">Freddie Bray, PhD<sup>1</sup></a></span></span> </div> <div class="meta-author"> <a class="meta-author-title is-b stats-meta-author-toggle" data-tog-target=".meta-author-content">Author Affiliations</a> <a class="meta-articleinfo-jumplink section-jump-link scroll-to stats-scroll-to-articleinfo" data-tab-toggle=".tab-nav-full-text" href="#248411668">Article Information</a> <div class="meta-author-content"> <ul class="meta-author-affiliations"> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>1</sup>Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>2</sup>The Daffodil Centre, The University of Sydney with Cancer Council New South Wales, Sydney, Australia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>3</sup>Melanoma Institute Australia, The University of Sydney, Sydney, Australia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>4</sup>Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>5</sup>Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia</div> </li> </ul> </div> </div> <div class="meta-citation-wrap"> <span class="meta-citation-journal-name">JAMA Dermatol. </span><span class="meta-citation"> 2022;158(5):495-503. doi:10.1001/jamadermatol.2022.0160</span> </div> </div> <div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links"> </div> <div class="widget-LinkedContentToolbar widget-instance-AMA_LinkedContentToolbar"> <div class="linked-content-toolbar"> <div class="hidden js-search-open-multimedia-by-default" showContentByDefault="False"></div> <div class="linked-content-controls"> <a class="linked-content-trigger td-n stats-graphical-abstract" href="#graphical-abstract-tab"> <i class="icon-visual-abstract"><span class="sr-t">visual abstract icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Visual <div>Abstract</div></div> </a> <a class="linked-content-trigger td-n stats-editorial-comment" href="#editorial-comment-tab"> <i class="icon-document"><span class="sr-t">editorial comment icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Editorial <div>Comment</div></div> </a> <a class="linked-content-trigger td-n stats-related-articles" href="#related-articles-tab"> <i class="icon-related"><span class="sr-t">related articles icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Related <div>Articles</div></div> </a> <a class="linked-content-trigger td-n stats-author-interviews" href="#author-interviews-tab"> <i class="icon-author_interview"><span class="sr-t">author interview icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Interviews</div> </a> <a class="linked-content-trigger td-n stats-more-multimedia" href="#more-multimedia-tab"> <i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Multimedia</div> </a> <a class="linked-content-trigger td-n stats-listen-to-this-article" href="#listen-to-this-article-tab"> <i class="icon-audio"><span class="sr-t">audio icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Listen to <div>this article</div></div> </a> </div> <div class="linked-content-tabs"> <div id="graphical-abstract-tab" class="linked-content-tab graphical-abstract-tab"> <div class="widget-SectionDisplay widget-instance-AMA_GraphicalAbstract_Tab"> </div> </div> <div id="editorial-comment-tab" class="linked-content-tab editorial-comment-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_EditorialComments"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2790346"> <div class="related-article-type">Editorial</div> <div class="related-article-title sb-tc">Melanoma Epidemiology—Pivoting to Low- and Middle-Income Countries</div> </a> <div class="related-article-authors">Mavis Obeng-Kusi, MPharm; Ivo Abraham, PhD</div> <div class="related-article-journal-name">JAMA Dermatology</div> </li> </ul> </div> </div> <div id="related-articles-tab" class="linked-content-tab related-article-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedArticle"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2802151"> <div class="related-article-type">JAMA Patient Page</div> <div class="related-article-title sb-tc">Patient Information: Melanoma</div> </a> <div class="related-article-authors">Jennifer Y. Wang, MD; Erica B. Wang, MD; Susan M. Swetter, MD</div> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedEditorsChoices"> </div> </div> <div id="author-interviews-tab" class="linked-content-tab linked-author-interviews-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_AuthorInterviews"> </div> </div> <div id="listen-to-this-article-tab" class="linked-content-tab linked-listen-to-this-article-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_ListenToThisArticle"> </div> </div> <div id="more-multimedia-tab" class="linked-content-tab more-multimedia-tab"> </div> </div> </div> </div> <div class="widget-ArticleFulltext widget-instance-AMA_Article_FullText_Widget"> <div class="article-full-text" data-userHasAccess="True"> <a class="article-section-id-anchor" id="248411630"></a> <span class="heading-text thm-col h3 cb section-type-keyPoints decorated-hed sb-sc ">Key Points</span><p><strong>Question</strong> <span>What are the global incidence and mortality patterns of cutaneous melanoma in 2020, and how are they estimated to change by 2040?</span></p><p><strong>Findings</strong> <span>This epidemiological assessment of global cancer data estimated that 325 000 new melanoma cases and 57 000 deaths due to melanoma occurred in 2020, with large geographic variations in incidence across countries and world regions. If 2020 rates remain stable, the global burden from melanoma is estimated to increase to 510 000 new cases and 96 000 deaths by 2040.</span></p><p><strong>Meaning</strong> <span>Melanoma remains an important public health concern globally and is characterized by high incidence in fair-skinned populations of European descent and disproportionate mortality in transitioning countries.</span></p> <a class="article-section-id-anchor" id="248411631"></a> <div class="h3 cb section-type-abstract decorated-hed "> <div class="heading-text thm-col sb-sc"> Abstract </div> </div> <p><strong>Importance</strong> <span>Despite many cases being preventable, cutaneous melanoma remains the most serious skin cancer worldwide. Understanding the scale and profile of the disease is vital to concentrate and reinforce global prevention efforts.</span></p><p><strong>Objective</strong> <span>To examine global patterns of cutaneous melanoma in 2020 and to provide projected estimates of cases and deaths by 2040.</span></p><p><strong>Design, Setting, and Participants</strong> <span>This population-based study used the GLOBOCAN 2020 database for global epidemiological assessment of new cases and deaths due to invasive melanoma.</span></p><p><strong>Main Outcomes and Measures</strong> <span>Age-standardized incidence and mortality rates were calculated per 100 000 person-years by country, world region, and 4-tier level of human development. Estimated numbers of cases and deaths were calculated for the year 2040.</span></p><p><strong>Results</strong> <span>A worldwide total of 325 000 new melanoma cases (174 000 males, 151 000 females) and 57 000 deaths (32 000 males, 25 000 females) was estimated for 2020. Large geographic variations existed across countries and world regions, with the highest incidence rates among males (42 per 100 000 person-years) and females (31 per 100 000 person-years) observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 person-years for females), and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 person-years for females). Melanoma continued to be rare in most African and Asian countries, with incidence rates commonly less than 1 per 100 000 person-years. Mortality rates peaked at 5 per 100 000 person-years in New Zealand, and geographic variations were less pronounced than for incidence. Melanoma was more frequent among males than females in most world regions. If 2020 rates continue, the burden from melanoma is estimated to increase to 510 000 new cases (a roughly 50% increase) and to 96 000 deaths (a 68% increase) by 2040.</span></p><p><strong>Conclusions and Relevance</strong> <span>This epidemiological assessment suggests that melanoma remains an important challenge to cancer control and public health globally, especially in fair-skinned populations of European descent.</span></p> <div class="movable-ad-target bta"> </div> <a class="article-section-id-anchor" id="248411636"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Introduction </div> </div> <a class="article-section-id-anchor" id="248411637"></a> <p class="para">With more than 1.5 million new cases estimated in 2020, skin cancers are the most commonly diagnosed group of cancers worldwide. Malignant melanomas (hereafter melanoma) account for approximately 1 in 5 of these cancers, with approximately 325 000 cases estimated globally in 2020. Historically a rare disease, melanoma incidence rates have been increasing during the last 50 years in fair-skinned populations of European ancestry.<sup><a href="#doi220006r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup><sup>,<a href="#doi220006r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup> Much of this increase is likely due to increased exposure of vulnerable populations to UV radiation, a strong and ubiquitous risk factor for melanoma, emitted naturally by the sun but also from artificial sources.<sup><a href="#doi220006r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup><sup>,<a href="#doi220006r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup> According to recent global estimates, more than three-quarters of all newly diagnosed melanoma cases can be attributed to UV radiation.<sup><a href="#doi220006r5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup></p> <a class="article-section-id-anchor" id="248411638"></a> <p class="para">Although the risk of melanoma generally increases with age and incidence is greater among older populations, melanoma is among the most common cancers in young adults.<sup><a href="#doi220006r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup> Incidence rates have stabilized or decreased among recent birth cohorts in a few countries, such as Australia and the US.<sup><a href="#doi220006r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup><sup>,<a href="#doi220006r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup> The reasons for these decreases in incidence are still debated and are likely associated with a combination of changes in lifestyle and social behavior, ethnic heterogeneity, and population admixture (ie, in which previously diverged or isolated genetic lineages mix). Yet with generational increases in melanoma incidence reported in most other high-risk populations and uniform increases observed in older age groups, the rates and number of melanoma diagnoses are projected to increase in the coming decades,<sup><a href="#doi220006r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup><sup>,<a href="#doi220006r9" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">9</a></sup> emphasizing the urgent need for targeted melanoma control measures.<sup><a href="#doi220006r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup> In parallel, mortality rates have continued increasing in high-incidence populations, with case fatality depending greatly on melanoma thickness at diagnosis.<sup><a href="#doi220006r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup><sup>,<a href="#doi220006r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup></p> <a class="article-section-id-anchor" id="248411639"></a> <p class="para">Herein, we examine the global burden of cutaneous melanoma in 2020 based on the GLOBOCAN estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer (IARC). We describe the variations in the magnitude and distribution of the disease geographically for the year 2020 and estimate the future burden in 2040.</p> <a class="article-section-id-anchor" id="248411640"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Methods </div> </div> <a class="article-section-id-anchor" id="248411641"></a> <p class="para">The numbers of new cases and deaths from invasive melanoma of the skin (<i>International Statistical Classification of Diseases, Tenth Revision</i> code C43) were extracted from the IARC GLOBOCAN 2020 database for 185 countries or territories by sex and 18 age groups (0-4, 5-9, . . . 80-84, and ≥85 years).<sup><a href="#doi220006r11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">11</a></sup><sup>-<a href="#doi220006r11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup> Corresponding population data for 2020 were extracted from the United Nations website.<sup><a href="#doi220006r14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup> The data sources and hierarchy of methods used in compiling the cancer estimates have been described in detail elsewhere.<sup><a href="#doi220006r11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">11</a></sup> In brief, the GLOBOCAN estimates were assembled at the national level using the best available sources of cancer incidence and mortality data within a given country. The methods used to derive the 2020 estimates corresponded to those used for previous years<sup><a href="#doi220006r15" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">15</a></sup><sup>-<a href="#doi220006r15" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup>; where applicable, priority was given to short-term projections and ratios of modeled mortality to incidence, whereas validity was dependent on the degree of representativeness and quality of the source information.<sup><a href="#doi220006r11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">11</a></sup> Specific details on the data sources and methods used to estimate incidence and mortality in a given country are provided at the IARC Global Cancer Observatory.<sup><a href="#doi220006r13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup> Data on race and ethnicity were not available. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (<a href="https://www.equator-network.org/reporting-guidelines/strobe/">STROBE</a>) reporting guideline. Because the GLOBOCAN project exclusively uses secondary and publicly available data, the IARC Ethics Committee deemed that no ethical approval was required for this study.</p> <a class="article-section-id-anchor" id="248411642"></a> <p class="para">We present a table and figures showing the estimated numbers of new cases and deaths, crude incidence and mortality rates, and 2 summary measures using direct standardization, namely, the age-standardized (incidence or mortality) rate per 100 000 person-years based on the 1966 Segi World standard population<sup><a href="#doi220006r18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup> adapted by Doll et al<sup><a href="#doi220006r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup> and the cumulative risk of developing or dying of cancer before 75 years of age expressed as a percentage, assuming the absence of competing causes of death.<sup><a href="#doi220006r20" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">20</a></sup> These measures allow for comparisons between populations adjusted for differences in age structures. We also provided a simple estimate of the future number of melanoma cases and deaths worldwide for the year 2040, based on demographic projections and scenarios of uniformly increasing, stable, or decreasing rates annually from the baseline year of 2020.</p> <a class="article-section-id-anchor" id="248411643"></a> <p class="para">The results are presented by country, and aggregated, across 20 world regions as defined by the United Nations<sup><a href="#doi220006r14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup> and according to the 4-tier Human Development Index (HDI) put forth by the United Nations in 2020.<sup><a href="#doi220006r21" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup> The latter is a means to assess the cancer burden at varying levels of development (low, medium, high, and very high HDIs). Throughout the article, we use the terms <i>transitioning</i>, <i>emerging</i>, and <i>lower HDI countries/economies</i> as synonyms for nations classified as low or medium HDI and the terms <i>transitioned</i> or <i>higher HDI countries/economies</i> for nations classified as high or very high HDI. All data were analyzed using R software, version 4.0.2 (R Foundation for Statistical Computing).</p> <a class="article-section-id-anchor" id="248411644"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Results </div> </div> <a class="article-section-id-anchor" id="248411645"></a> <p class="para">In 2020, an estimated 325 000 persons (174 000 males, 151 000 females) worldwide were diagnosed as having melanoma, and approximately 57 000 persons (32 000 males, 25 000 females) died of the disease. Of all newly diagnosed cases in 2020, 259 000 (79.7%) were persons older than 50 years of age, and of all deaths in 2020, 50 000 persons (87.7%) were older than 50 years of age. The <a href="#doi220006t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table</a> gives the number of newly diagnosed melanoma cases and deaths, the incidence and mortality age-standardized rate, and the cumulative risk of developing and dying of melanoma by world region and sex. The highest incidence rates for both males (42 per 100 000 person-years) and females (31 per 100 000 person-years) were observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 persons for females) and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 person-years for females). The lowest incidence rates occurred in most regions of Africa and Asia, with rates less than 1 per 100 000 person-years (except for Middle and Southern Africa as well as Western Asia). The highest mortality rates (4 per 100 000 person-years for males, 2 per 100 000 person-years for females) were observed in Australia/New Zealand, whereas rates in most other world regions were much lower, ranging between 0.2-1.0 per 100 000 person-years.</p> <a class="article-section-id-anchor" id="248411647"></a> <p class="para"><a href="#doi220006f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 1</a> presents the distribution of incident melanoma cases and deaths in 2020 across world regions. With 150 672 cases, close to half the global melanoma cases occurred in Europe (46.4%), followed by North America (32.4%). Most melanoma deaths were observed in Central and Eastern Europe (16.3%), followed by North America (14.7%) and Western Europe (13.0%). Although 5.9% of all melanoma cases occurred in Oceania, the continent’s share of melanoma deaths was about half that (ie, 3.4% of global deaths). This is in contrast to Asia, where 7.3% of all cases but 21.0% of all deaths occurred, and to Africa, which contributed 2.1% of cases yet had 4.7% of global melanoma deaths.</p> <a class="article-section-id-anchor" id="248411649"></a> <p class="para">Worldwide, melanoma was more common in males (174 000 cases) than in females (151 000 cases). A male predominance in incidence was consistently observed across world regions, apart from Eastern and Western Africa as well as Northern Europe and Melanesia, where rates of melanoma in females exceeded those observed in males. The cumulative risk of developing melanoma was highest in Australia/New Zealand, with approximately 1 in 20 males and 1 in 30 females being affected by 75 years of age (<a href="#doi220006t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table</a>). The corresponding cumulative risk of dying of melanoma before 75 years of age in Australia/New Zealand was 1 in 280 males and 1 in 555 females.</p> <a class="article-section-id-anchor" id="248411650"></a> <p class="para">At the national level, estimated incidence varied by more than 36-fold (from 36 per 100 000 person-years in Australia to fewer than 1 per 100 000 person-years in many African and Asian countries), and mortality varied by more than 5-fold (from 5 per 100 000 person-years in New Zealand to less than 1 per 100 000 person-years in many African and Asian countries) (<a href="#doi220006f2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 2</a>). Variations in incidence were also marked across countries in high-risk world regions. For example, in Western Europe, incidence rates ranged from 14.2 per 100 000 person-years among females and 13.2 per 100 000 person-years among males in Austria, through to 27.4 per 100 000 person-years among females and 27.1 per 100 000 person-years among males in the Netherlands. In Northern Europe, they ranged from 5.9 per 100 000 person-years among females and 7.3 per 100 000 person-years among males in Latvia to 33.6 per 100 000 person-years among females and 26.2 per 100 000 person-years among males in Denmark (eFigure 1 and eFigure 2 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-DOI220006-1">Supplement</a>). Mortality from melanoma was relatively more similar across world regions (eFigure 3 and eFigure 4 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-DOI220006-1">Supplement</a>).</p> <a class="article-section-id-anchor" id="248411652"></a> <p class="para">In 2020, melanoma incidence rates were approximately 10 time as high in very high HDI countries than in low HDI countries; however, this gap was only 3- to 5-fold for a similar comparison of mortality rates. A strong gradient across human development level was observed for melanoma incidence. In terms of absolute cases and deaths, 85.6% of all melanoma cases and 67.2% of all melanoma deaths worldwide occurred in very high HDI countries (<a href="#doi220006t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table</a>).</p> <a class="article-section-id-anchor" id="248411653"></a> <p class="para">The number of newly diagnosed cases of melanoma was estimated to increase by more than 50% by 2040, to 510 000. Similarly, melanoma deaths were estimated to increase by approximately 68%, from 57 000 in 2020 to 96 000 in 2040, assuming rates in 2020 remained stable (<a href="#doi220006f3" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 3</a>). These projections were calculated solely by assuming changes in world population size and age structure and did not account for possible changes in age-specific incidence globally or within countries. Decreases in incidence and mortality rates would need to be greater than 2% globally to ensure there would be fewer melanoma cases in 2040 than there were in 2020.</p> <a class="article-section-id-anchor" id="248411655"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Discussion </div> </div> <a class="article-section-id-anchor" id="248411656"></a> <p class="para">This population-based epidemiological study found that melanoma constituted a considerable cancer burden in 2020 and was largely concentrated in highly developed countries, predominantly inhabited by people of European origin, with lighter skin pigmentation and therefore higher risk and higher susceptibility to the carcinogenic effects of solar radiation. There were marked geographic variations in incidence and mortality rates across countries and world regions, with the highest incidence observed in the fair-skinned populations of Australia/New Zealand, Western and Northern Europe (such as Denmark, Norway, and the Netherlands), and North America. By contrast, melanoma remained rare in most parts of Africa, South and Central America, and Asia. With mortality rates peaking at 5 per 100 000 person-years in New Zealand, geographic differences in mortality were similar, but with lower rates and less between- and within-region variability. Yet the global share of deaths relative to cases remained disproportionally high in Asia and Africa compared with other world regions.</p> <a class="article-section-id-anchor" id="248411657"></a> <p class="para">Exposure to UV radiation is the most important risk factor for melanoma and nonmelanoma skin cancers, as it has been shown to lead to carcinogenic mutations and the suppression of certain aspects of the immune system.<sup><a href="#doi220006r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup> Evidence from both epidemiological and mechanistic studies support this evaluation, with continuous increases in skin cancer incidence reported over time and across populations. Historically a rare disease, the incidence of melanoma has been increasing progressively for several decades.<sup><a href="#doi220006r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup> The magnitude of incidence and the rate of increase varies considerably across populations, ethnic groups, and geographic locations, and even within populations across age and sex. Different patterns in incidence rates depending on latitude and north-south gradients have been observed in several countries and world regions. Although melanoma rates continue to increase in most European countries, rates in North America and Oceania appeared to have leveled off in recent years.<sup><a href="#doi220006r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup><sup>,<a href="#doi220006r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a>,<a href="#doi220006r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#doi8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a>,<a href="#doi220006r22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> Temporal variations in melanoma incidence in high-risk populations are associated with a strong cohort effect, with rates stabilizing or decreasing among recent generations in some countries.<sup><a href="#doi220006r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup> In Australia, the country with the highest melanoma incidence rates worldwide, more than 95% of all melanoma cases have been attributed to high ambient levels of UV radiation exposure.<sup><a href="#doi220006r5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup><sup>,<a href="#doi220006r23" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">23</a></sup><sup>,<a href="#doi220006r24" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">24</a></sup> Melanoma incidence in Australia has been decreasing since 2005 (by −0.7% per year), attributable to multiple converging forces, including secular changes in outdoor activity, nationwide changes, and targeted prevention activities (eg, mass media campaigns, sun-safe policies, supportive environments such as shade, and availability of sun-protection products). In addition, there is evidence that the proportion of people with fair pigmentation who are highly susceptible to melanoma is diminishing over time.<sup><a href="#doi220006r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#doi220006r25" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">25</a></sup> Incidence rates in New Zealand increased until the early 2010s but are projected to decrease in the future.<sup><a href="#doi220006r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup> Although the incidence and mortality levels were much lower outside of Australia/New Zealand, North America, and Europe, important heterogeneity in patterns and trends were also observed across populations in low-incidence regions, such as in South and Central America.<sup><a href="#doi220006r26" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">26</a></sup> Even with such diverse temporal patterns by birth cohort and age in different populations in each world region, we noted that a global decrease in rates of greater than 2.0% annually would be needed to ensure that there are fewer melanoma cases in 2040 than there were 2020.</p> <a class="article-section-id-anchor" id="248411658"></a> <p class="para">The markedly lower incidence rates in darker-skinned populations have been associated with protective phenotypes related to UV radiation sensitivity, such as pigmented skin types and few freckles, as well as other associated factors, including number of atypical nevi or sunbathing behavior.<sup><a href="#doi220006r27" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">27</a></sup> People of European origin typically have a much higher risk of developing skin cancer, which is partly attributable to decreased photoprotection from lower levels of melanin in the epidermis and higher proportions of pheomelanin rather than eumelanin. With an estimated 10% of cutaneous melanomas occurring in familial settings, the risk of melanoma is also influenced by genetics.<sup><a href="#doi220006r28" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">28</a></sup> Substantial advances in molecular and genetic research in recent years have led to an improved characterization of gene mutations associated with melanoma.<sup><a href="#doi220006r29" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">29</a></sup> For example, an estimated 35% to 40% of familial melanomas have been linked to mutations in the 2 main highly penetrant genes associated with melanoma (<i>CDKN2A/p16</i> and <i>CDK4</i>).<sup><a href="#doi220006r30" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">30</a></sup><sup>,<a href="#doi220006r31" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">31</a></sup> Furthermore, common variants causing loss of function of the human melanocortin-1 receptor gene (<i>MC1R</i>), which plays a crucial role in human skin and hair pigmentation, have been found to increase the risk of developing melanoma,<sup><a href="#doi220006r32" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">32</a></sup> as have numerous other genes involved in pigmentation, nevus, and telomere length pathways.<sup><a href="#doi220006r29" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">29</a></sup> The reason melanoma rarely affects fair-skinned individuals of East Asian descent remains largely unknown.</p> <a class="article-section-id-anchor" id="248411659"></a> <p class="para">Melanoma is more common in men than in women in most parts of the world. This, however, differs by age, with rates in women exceeding those in men before 50 years of age. Sex differences also exist with respect to the anatomic localization of the lesion; melanoma is more frequent on the trunk in men and on the lower limbs in women.<sup><a href="#doi220006r33" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">33</a></sup> The reasons for this are still poorly understood, and it remains to be uncovered how much of the melanoma development can be attributed to gender role–specific behaviors or to biologically intrinsic differences, notably the role of sex hormones.<sup><a href="#doi220006r34" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">34</a></sup> In addition, in terms of age-specific incidence patterns, melanoma is particular, following a bimodal distribution with a peak at younger ages for melanomas arising on less exposed sites (eg, trunk, limbs) and a peak at older ages for melanomas arising on more exposed sites (eg, ears, face, neck, and scalp in men). In fact, melanoma is not uncommon even among patients younger than 30 years and is one of the most common cancers in young adults, especially young women.<sup><a href="#doi220006r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup><sup>,<a href="#doi220006r35" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">35</a></sup></p> <a class="article-section-id-anchor" id="248411660"></a> <p class="para">Despite being largely preventable, melanoma is the most serious skin cancer owing to its high potential for metastasis. Mortality rates were highest in New Zealand and Australia, reflecting the high burden and increasing incidence of melanoma in many high-income countries.<sup><a href="#doi220006r36" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">36</a></sup><sup>-<a href="#doi220006r36" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">38</a></sup> Yet although most transitioning countries carry a relatively low burden of melanoma cases, their share of melanoma deaths is often disproportionate, for example, in most parts of Asia and Africa, most likely owing to higher case fatality. Surviving melanoma depends on the sex of the patient (superior female survival), subtype (eg, acral lentiginous melanomas—unrelated to UV radiation exposure and representing a higher proportion of melanomas diagnosed in darker-skinned populations—have a generally poor prognosis), tumor thickness, body site, and, most importantly, stage at diagnosis.<sup><a href="#doi220006r39" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">39</a></sup> Five-year survival estimates range between 60% and 90% in most parts of the world and exceed 90% in several high-income (and high-incidence) countries, such as the US, parts of Europe, Australia, and New Zealand, in which skin cancer awareness and clinical skin checks are more common.<sup><a href="#doi220006r40" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">40</a></sup> In line with this, a lower Breslow thickness at diagnosis and thus higher incidence of tumors with good prognosis have been reported in those countries.<sup><a href="#doi220006r41" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">41</a></sup> By contrast, outcomes are estimated to be poorer in low- and middle-income settings.<sup><a href="#doi220006r42" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">42</a></sup> A rapid decrease in mortality rates for melanoma has been documented in the US by 6.4% per year since 2013 through 2017 after the introduction of new therapies, including immune checkpoint inhibitors and targeted therapies for metastatic melanoma.<sup><a href="#doi220006r43" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">43</a></sup><sup>,<a href="#doi220006r44" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">44</a></sup> Yet there are still a high number of deaths from thin melanomas in both Australia<sup><a href="#doi220006r45" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">45</a></sup> and the US, reinforcing the importance of prevention and early detection in high-income settings.</p> <a class="article-section-id-anchor" id="248411661"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Limitations </div> </div> <a class="article-section-id-anchor" id="248411662"></a> <p class="para">There are important limitations in this study. The numbers and rates presented are estimates based on the best available data from population-based cancer registries that have been thoroughly reviewed. Yet some caution is warranted when interpreting the findings, especially for countries in which estimates were based on proxy data (eg, rates from neighboring countries).<sup><a href="#doi220006r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup> It is also likely that the incidence of melanoma was underreported in some parts of the world because of either lack of diagnostic facilities or a lack of reporting cases treated in outpatient settings. Given those prospects of underdiagnosis and incomplete registration, underestimation of cases and deaths in some populations therefore cannot be wholly discounted.<sup><a href="#doi220006r26" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">26</a></sup> These artifacts may be counterbalanced by overreporting and increasing detection of thin melanomas, as reported in high-income settings, as a result of increased diagnostic scrutiny.<sup><a href="#doi220006r46" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">46</a></sup><sup>-<a href="#doi220006r46" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">48</a></sup> Supporting this hypothesis and despite stabilizing or decreasing incidence rates among recent birth cohorts in some populations at high risk,<sup><a href="#doi220006r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup><sup>,<a href="#doi220006r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup> data from the US show melanoma incidence rates increasing by up to 6% per year for several decades, while mortality rates have remained constant or decreased,<sup><a href="#doi220006r49" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">49</a></sup> possibly due to overdiagnosis.<sup><a href="#doi220006r50" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">50</a></sup> The implementation of skin cancer screening programs and improved detection technologies as well as increasing awareness in the population have likely influenced these temporal patterns. Skin cancer screening programs in Germany<sup><a href="#doi220006r51" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">51</a></sup> and other countries<sup><a href="#doi220006r52" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">52</a></sup> have been shown to have inflated incidence, with only limited evidence of benefits resulting from screening or decreased mortality. Increasing incidence rates in the UK, which were steepest for stage I tumors, could be attributed to both a genuine increase in risk but also some degree of overdiagnosis.<sup><a href="#doi220006r53" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">53</a></sup> The extent to which melanoma current and future incidence and mortality trends might be associated with overdiagnosis warrants further study and should ideally be based on tumor thickness or stage at diagnosis.</p> <a class="article-section-id-anchor" id="248411663"></a> <p class="para">The GLOBOCAN estimates did not reflect the effect of the COVID-19 pandemic because they were based on extrapolations of cancer data collected in earlier years. Although we found a positive association between melanoma incidence and HDI (as a proxy for affluence), it is important to reiterate that this association did not account for confounding by skin color and differing distributions of pigmentation in the populations of interest. In consequence, associations between melanoma mortality and HDI were attributable in part to higher background incidence levels in the same countries. Future analyses by race or ethnicity (or ideally skin color and type) are crucial to disentangle these associations.</p> <a class="article-section-id-anchor" id="248411664"></a> <p class="para">We age-adjusted incidence and mortality rates to allow for fair comparisons across populations. As a relative measure, the world standard population<sup><a href="#doi220006r18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup><sup>,<a href="#doi220006r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup> was used for consistency and continuity,<sup><a href="#doi220006r54" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">54</a></sup> although some differences in the absolute ranking of age-adjusted melanoma rates may occur were another standard used, particularly in high-incidence countries, where the present age structures were quite different from that of the applied standard population. The crude rates (as provided in the <a href="#doi220006t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table</a>) remain of relevance in measuring the “load” of the melanoma burden in a given population.</p> <a class="article-section-id-anchor" id="248411665"></a> <p class="para">The future projections were estimated based on the assumption that incidence and mortality rates will remain unchanged between 2020 and 2040. The difference in the current and future burden of melanoma presented here was therefore solely attributable to projected national demographic changes (population growth and aging) and did not account for national or within-country temporal variations. More detailed and accurate prediction exercises, such as those based on age-period-cohort modeling, will require high-quality long-term data, ideally augmented with other information on risk factors, interventions, and population composition,<sup><a href="#doi220006r55" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">55</a></sup> which are lacking in many world regions at present. In addition, highly developed countries appear to be entering a transition phase with respect to deaths from melanoma; the advent of new immune therapies and targeted therapies since the mid-2010s is already leading to decreasing mortality rates.<sup><a href="#doi220006r56" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">56</a></sup> Estimated projections (especially of mortality) were thus challenging and should be interpreted with caution.</p> <a class="article-section-id-anchor" id="248411666"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Conclusions </div> </div> <a class="article-section-id-anchor" id="248411667"></a> <p class="para">Melanoma is the most lethal form of skin cancer; this epidemiological assessment found a heavy public health and economic burden, and our projections suggest that it will remain so in the coming decades. Although marked geographical variations remain, melanoma continues to mainly affect fair-skinned populations of European descent residing in high-income countries. In addition, the global share of melanoma deaths was disproportionally high in Asia and Africa compared to other world regions. Despite the increasing global melanoma burden, many cases and deaths may be averted through effective public health measures that target primary prevention and early detection combined with curative treatment.</p> <a class="article-section-id-anchor" id="248411668"></a> <div class="h3 cb section-type-acknowledgements has-back-to-top"> <a href="#top" class="section-jump-link back-to-top" data-tab-toggle=".tab-nav-full-text">Back to top</a> <div class="heading-text thm-col sb-sc"> Article Information </div> </div> <p class="para"><strong>Accepted for Publication:</strong> January 16, 2022.</p><p class="parapublished-online"><strong>Published Online:</strong> March 30, 2022. doi:10.1001/jamadermatol.2022.0160</p><p class="authorInfoSection"><strong>Corresponding Author:</strong> Melina Arnold, PhD, Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France (<a href="mailto:arnoldm@iarc.fr" target="_blank">arnoldm@iarc.fr</a>).</p><p class="paraauthor-contributions"><strong>Author Contributions</strong>: Dr Arnold had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.</p><p class="para"><i>Concept and design:</i> Arnold, Bray.</p><p class="para"><i>Acquisition, analysis, or interpretation of data:</i> All authors.</p><p class="para"><i>Drafting of the manuscript:</i> Arnold, Singh, Vignat, Meheus.</p><p class="para"><i>Critical revision of the manuscript for important intellectual content:</i> Arnold, Singh, Laversanne, Vaccarella, Meheus, Cust, de Vries, Whiteman, Bray.</p><p class="para"><i>Statistical analysis:</i> Laversanne, Vignat.</p><p class="para"><i>Administrative, technical, or material support:</i> Singh, Cust, de Vries, Bray.</p><p class="para"><i>Supervision:</i> Singh, Vaccarella, Bray.</p><p class="parafinancial-disclosure"><strong>Conflict of Interest Disclosures:</strong> Dr Cust reported receiving a fellowship from the Australian National Health and Medical Research Council (NHMRC) outside the submitted work. Dr de Vries reported receiving personal fees from Amgen outside the submitted work. Dr Whiteman reported receiving salary support and competitive grants from the Australian NHMRC during the conduct of the study. No other disclosures were reported.</p><p class="parafunding-statement"><strong>Funding/Support:</strong> Dr Cust is supported by a Career Development Fellowship (1147843) from the Australian NHMRC.</p><p class="para"><strong>Role of the Funder/Sponsor:</strong> The funder had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.</p><p class="para"><strong>Disclaimer:</strong> Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization.</p><p class="para"><strong>Additional Information:</strong> All data are publicly available and accessible through the Global Cancer Observatory (<a href="https://gco.iarc.fr/today/home">https://gco.iarc.fr/today/home</a>).</p> <a class="article-section-id-anchor" id="248411669"></a> <div class="h3 cb section-type-references "> <div class="heading-text thm-col sb-sc"> References </div> </div> <div class="references"><div class="reference"><a class="reference-number" id="doi220006r1">1.</a><div class="reference-content">Erdmann F, Lortet-Tieulent J, Schüz J, et al. International trends in the incidence of malignant melanoma 1953-2008—are recent generations at higher or lower risk? <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2013;132(2):385-400. doi:<a href="http://dx.doi.org/10.1002/ijc.27616">10.1002/ijc.27616</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22532371" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=International%20trends%20in%20the%20incidence%20of%20malignant%20melanoma%201953-2008%E2%80%94are%20recent%20generations%20at%20higher%20or%20lower%20risk%3F&author=F%20Erdmann&author=J%20Lortet-Tieulent&author=J%20Schüz&publication_year=2013&journal=Int%20J%20Cancer&volume=132&pages=385-400" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.27616" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.27616" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r2">2.</a><div class="reference-content">Arnold M, Holterhues C, Hollestein LM, et al. Trends in incidence and predictions of cutaneous melanoma across Europe up to 2015. <i xmlns:helper="urn:XsltStringHelper"> J Eur Acad Dermatol Venereol</i>. 2014;28(9):1170-1178. doi:<a href="http://dx.doi.org/10.1111/jdv.12236">10.1111/jdv.12236</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/23962170" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20incidence%20and%20predictions%20of%20cutaneous%20melanoma%20across%20Europe%20up%20to%202015.&author=M%20Arnold&author=C%20Holterhues&author=LM%20Hollestein&publication_year=2014&journal=J%20Eur%20Acad%20Dermatol%20Venereol&volume=28&pages=1170-1178" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/jdv.12236" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1111/jdv.12236" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r3">3.</a><div class="reference-content">El Ghissassi F, Baan R, Straif K, et al; WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens—part D: radiation. <i xmlns:helper="urn:XsltStringHelper"> Lancet Oncol</i>. 2009;10(8):751-752. doi:<a href="http://dx.doi.org/10.1016/S1470-2045(09)70213-X">10.1016/S1470-2045(09)70213-X</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19655431" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20review%20of%20human%20carcinogens%E2%80%94part%20D%3A%20radiation.&author=F%20El Ghissassi&author=R%20Baan&author=K%20Straif&publication_year=2009&journal=Lancet%20Oncol&volume=10&pages=751-752" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S1470-2045(09)70213-X" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S1470-2045(09)70213-X" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r4">4.</a><div class="reference-content">International Agency for Research on Cancer. <i>Radiation: Volume 100 D: A Review of Human Carcinogens: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans</i>. IARC Publications; 2012.</div></div><div class="reference"><a class="reference-number" id="doi220006r5">5.</a><div class="reference-content">Arnold M, de Vries E, Whiteman DC, et al. Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2018;143(6):1305-1314. doi:<a href="http://dx.doi.org/10.1002/ijc.31527">10.1002/ijc.31527</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29659012" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Global%20burden%20of%20cutaneous%20melanoma%20attributable%20to%20ultraviolet%20radiation%20in%202012.&author=M%20Arnold&author=E%20de Vries&author=DC%20Whiteman&publication_year=2018&journal=Int%20J%20Cancer&volume=143&pages=1305-1314" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v143.6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v143.6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r6">6.</a><div class="reference-content">Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. <i xmlns:helper="urn:XsltStringHelper"> Lancet Oncol</i>. 2017;18(12):1579-1589. doi:<a href="http://dx.doi.org/10.1016/S1470-2045(17)30677-0">10.1016/S1470-2045(17)30677-0</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29111259" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20incidence%20and%20mortality%20among%20young%20adults%20aged%2020-39%20years%20worldwide%20in%202012%3A%20a%20population-based%20study.&author=MM%20Fidler&author=S%20Gupta&author=I%20Soerjomataram&author=J%20Ferlay&author=E%20Steliarova-Foucher&author=F%20Bray&publication_year=2017&journal=Lancet%20Oncol&volume=18&pages=1579-1589" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S1470-2045(17)30677-0" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S1470-2045(17)30677-0" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r7">7.</a><div class="reference-content">Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. <i xmlns:helper="urn:XsltStringHelper"> J Invest Dermatol</i>. 2016;136(6):1161-1171. doi:<a href="http://dx.doi.org/10.1016/j.jid.2016.01.035">10.1016/j.jid.2016.01.035</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26902923" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20growing%20burden%20of%20invasive%20melanoma%3A%20projections%20of%20incidence%20rates%20and%20numbers%20of%20new%20cases%20in%20six%20susceptible%20populations%20through%202031.&author=DC%20Whiteman&author=AC%20Green&author=CM%20Olsen&publication_year=2016&journal=J%20Invest%20Dermatol&volume=136&pages=1161-1171" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jid.2016.01.035" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.jid.2016.01.035" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r8">8.</a><div class="reference-content">Garbe C, Keim U, Gandini S, et al. Epidemiology of cutaneous melanoma and keratinocyte cancer in white populations 1943-2036. <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2021;152:18-25. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2021.04.029">10.1016/j.ejca.2021.04.029</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34062483" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Epidemiology%20of%20cutaneous%20melanoma%20and%20keratinocyte%20cancer%20in%20white%20populations%201943-2036.&author=C%20Garbe&author=U%20Keim&author=S%20Gandini&publication_year=2021&journal=Eur%20J%20Cancer&volume=152&pages=18-25" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2021.04.029" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2021.04.029" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r9">9.</a><div class="reference-content">Paulson KG, Gupta D, Kim TS, et al. Age-specific incidence of melanoma in the United States. <i xmlns:helper="urn:XsltStringHelper"> JAMA Dermatol</i>. 2020;156(1):57-64. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2019.3353">10.1001/jamadermatol.2019.3353</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31721989" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Age-specific%20incidence%20of%20melanoma%20in%20the%20United%20States.&author=KG%20Paulson&author=D%20Gupta&author=TS%20Kim&publication_year=2020&journal=JAMA%20Dermatol&volume=156&pages=57-64" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamadermatol.2019.3353" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jamadermatol.2019.3353" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r10">10.</a><div class="reference-content">Baade PD, Whiteman DC, Janda M, et al. Long-term deaths from melanoma according to tumor thickness at diagnosis. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2020;147(5):1391-1396. doi:<a href="http://dx.doi.org/10.1002/ijc.32930">10.1002/ijc.32930</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32067220" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Long-term%20deaths%20from%20melanoma%20according%20to%20tumor%20thickness%20at%20diagnosis.&author=PD%20Baade&author=DC%20Whiteman&author=M%20Janda&publication_year=2020&journal=Int%20J%20Cancer&volume=147&pages=1391-1396" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v147.5" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v147.5" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r11">11.</a><div class="reference-content">Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: an overview. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2021. doi:<a href="http://dx.doi.org/10.1002/ijc.33588">10.1002/ijc.33588</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33818764" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20statistics%20for%20the%20year%202020%3A%20an%20overview.&author=J%20Ferlay&author=M%20Colombet&author=I%20Soerjomataram&publication_year=2021&journal=Int%20J%20Cancer&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v149.4" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v149.4" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r12">12.</a><div class="reference-content">Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. <i xmlns:helper="urn:XsltStringHelper"> CA Cancer J Clin</i>. 2021;71(3):209-249. doi:<a href="http://dx.doi.org/10.3322/caac.21660">10.3322/caac.21660</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33538338" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Global%20cancer%20statistics%202020%3A%20GLOBOCAN%20estimates%20of%20incidence%20and%20mortality%20worldwide%20for%2036%20cancers%20in%20185%20countries.&author=H%20Sung&author=J%20Ferlay&author=RL%20Siegel&publication_year=2021&journal=CA%20Cancer%20J%20Clin&volume=71&pages=209-249" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3322/caac.v71.3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3322/caac.v71.3" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r13">13.</a><div class="reference-content">International Agency for Research on Cancer: Global Cancer Observatory. Cancer today. Published 2021. Accessed April 28, 2021. <a href="https://gco.iarc.fr/today/home">https://gco.iarc.fr/today/home</a></div></div><div class="reference"><a class="reference-number" id="doi220006r14">14.</a><div class="reference-content">United Nations Statistics Division. Standard country or area codes for statistical use (M49): aggregated. Published 2021. Accessed April 28, 2021.</div></div><div class="reference"><a class="reference-number" id="doi220006r15">15.</a><div class="reference-content">Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2019;144(8):1941-1953. doi:<a href="http://dx.doi.org/10.1002/ijc.31937">10.1002/ijc.31937</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30350310" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimating%20the%20global%20cancer%20incidence%20and%20mortality%20in%202018%3A%20GLOBOCAN%20sources%20and%20methods.&author=J%20Ferlay&author=M%20Colombet&author=I%20Soerjomataram&publication_year=2019&journal=Int%20J%20Cancer&volume=144&pages=1941-1953" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v144.8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v144.8" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r16">16.</a><div class="reference-content">Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2015;136(5):E359-E386. doi:<a href="http://dx.doi.org/10.1002/ijc.29210">10.1002/ijc.29210</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/25220842" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20incidence%20and%20mortality%20worldwide%3A%20sources%2C%20methods%20and%20major%20patterns%20in%20GLOBOCAN%202012.&author=J%20Ferlay&author=I%20Soerjomataram&author=R%20Dikshit&publication_year=2015&journal=Int%20J%20Cancer&volume=136&pages=E359-E386" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.29210" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.29210" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r17">17.</a><div class="reference-content">Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2010;127(12):2893-2917. doi:<a href="http://dx.doi.org/10.1002/ijc.25516">10.1002/ijc.25516</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21351269" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimates%20of%20worldwide%20burden%20of%20cancer%20in%202008%3A%20GLOBOCAN%202008.&author=J%20Ferlay&author=HR%20Shin&author=F%20Bray&author=D%20Forman&author=C%20Mathers&author=DM%20Parkin&publication_year=2010&journal=Int%20J%20Cancer&volume=127&pages=2893-2917" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.v127:12" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.v127:12" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r18">18.</a><div class="reference-content">Segi M, Kurihara M. <i xmlns:helper="urn:XsltStringHelper"> Cancer Mortality for Selected Sites in 24 Countries (1950-1957)</i>. 2nd ed. Tohoku University of Medicine; 1960.</div></div><div class="reference"><a class="reference-number" id="doi220006r19">19.</a><div class="reference-content">Doll R, Payne P, Waterhouse J, eds. <i xmlns:helper="urn:XsltStringHelper"> Cancer Incidence in Five Continents: A Technical Report</i>. Springer; 1966. doi:<a href="http://dx.doi.org/10.1007/978-3-642-85849-9">10.1007/978-3-642-85849-9</a></div></div><div class="reference"><a class="reference-number" id="doi220006r20">20.</a><div class="reference-content">Day NE. Cancer incidence in five continents. cumulative rate and cumulative risk. <i xmlns:helper="urn:XsltStringHelper"> IARC Sci Publ</i>. 1992;(120):862-864.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/1284607" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20incidence%20in%20five%20continents.%20cumulative%20rate%20and%20cumulative%20risk.&author=NE%20Day&publication_year=1992&journal=IARC%20Sci%20Publ&volume=&pages=862-864" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a></div></div><div class="reference"><a class="reference-number" id="doi220006r21">21.</a><div class="reference-content">United Nations Development Programme. <i xmlns:helper="urn:XsltStringHelper"> Human Development Report 2020</i>. United Nations; 2020.</div></div><div class="reference"><a class="reference-number" id="doi220006r22">22.</a><div class="reference-content">Dulskas A, Cerkauskaite D, Vincerževskiene I, Urbonas V. Trends in incidence and mortality of skin melanoma in Lithuania 1991-2015. <i xmlns:helper="urn:XsltStringHelper"> Int J Environ Res Public Health</i>. 2021;18(8):4165. doi:<a href="http://dx.doi.org/10.3390/ijerph18084165">10.3390/ijerph18084165</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33920754" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20incidence%20and%20mortality%20of%20skin%20melanoma%20in%20Lithuania%201991-2015.&author=A%20Dulskas&author=D%20Cerkauskaite&author=I%20Vincerževskiene&author=V%20Urbonas&publication_year=2021&journal=Int%20J%20Environ%20Res%20Public%20Health&volume=18&pages=4165" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3390/ijerph18084165" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3390/ijerph18084165" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r23">23.</a><div class="reference-content">Olsen CM, Wilson LF, Green AC, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. <i xmlns:helper="urn:XsltStringHelper"> Aust N Z J Public Health</i>. 2015;39(5):471-476. doi:<a href="http://dx.doi.org/10.1111/1753-6405.12470">10.1111/1753-6405.12470</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26437734" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancers%20in%20Australia%20attributable%20to%20exposure%20to%20solar%20ultraviolet%20radiation%20and%20prevented%20by%20regular%20sunscreen%20use.&author=CM%20Olsen&author=LF%20Wilson&author=AC%20Green&publication_year=2015&journal=Aust%20N%20Z%20J%20Public%20Health&volume=39&pages=471-476" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/1753-6405.12470" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1111/1753-6405.12470" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r24">24.</a><div class="reference-content">Armstrong BK, Kricker A. How much melanoma is caused by sun exposure? <i xmlns:helper="urn:XsltStringHelper"> Melanoma Res</i>. 1993;3(6):395-401. doi:<a href="http://dx.doi.org/10.1097/00008390-199311000-00002">10.1097/00008390-199311000-00002</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8161879" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=How%20much%20melanoma%20is%20caused%20by%20sun%20exposure%3F&author=BK%20Armstrong&author=A%20Kricker&publication_year=1993&journal=Melanoma%20Res&volume=3&pages=395-401" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00008390-199311000-00002" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00008390-199311000-00002" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r25">25.</a><div class="reference-content">Iannacone MR, Green AC. Towards skin cancer prevention and early detection: evolution of skin cancer awareness campaigns in Australia. <i xmlns:helper="urn:XsltStringHelper"> Melanoma Manag</i>. 2014;1(1):75-84. doi:<a href="http://dx.doi.org/10.2217/mmt.14.6">10.2217/mmt.14.6</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30190812" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Towards%20skin%20cancer%20prevention%20and%20early%20detection%3A%20evolution%20of%20skin%20cancer%20awareness%20campaigns%20in%20Australia.&author=MR%20Iannacone&author=AC%20Green&publication_year=2014&journal=Melanoma%20Manag&volume=1&pages=75-84" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.2217/mmt.14.6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.2217/mmt.14.6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r26">26.</a><div class="reference-content">de Vries E, Sierra M, Piñeros M, Loria D, Forman D. The burden of cutaneous melanoma and status of preventive measures in Central and South America. <i xmlns:helper="urn:XsltStringHelper"> Cancer Epidemiol</i>. 2016;44(suppl 1):S100-S109. doi:<a href="http://dx.doi.org/10.1016/j.canep.2016.02.005">10.1016/j.canep.2016.02.005</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27034057" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20burden%20of%20cutaneous%20melanoma%20and%20status%20of%20preventive%20measures%20in%20Central%20and%20South%20America.&author=E%20de Vries&author=M%20Sierra&author=M%20Piñeros&author=D%20Loria&author=D%20Forman&publication_year=2016&journal=Cancer%20Epidemiol&volume=44&pages=S100-S109" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.canep.2016.02.005" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.canep.2016.02.005" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r27">27.</a><div class="reference-content">Purdue MP, From L, Armstrong BK, et al; Genes, Environment, and Melanoma Study Group. Etiologic and other factors predicting nevus-associated cutaneous malignant melanoma. <i xmlns:helper="urn:XsltStringHelper"> Cancer Epidemiol Biomarkers Prev</i>. 2005;14(8):2015-2022. doi:<a href="http://dx.doi.org/10.1158/1055-9965.EPI-05-0097">10.1158/1055-9965.EPI-05-0097</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16103454" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Etiologic%20and%20other%20factors%20predicting%20nevus-associated%20cutaneous%20malignant%20melanoma.&author=MP%20Purdue&author=L%20From&author=BK%20Armstrong&publication_year=2005&journal=Cancer%20Epidemiol%20Biomarkers%20Prev&volume=14&pages=2015-2022" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1158/1055-9965.EPI-05-0097" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1158/1055-9965.EPI-05-0097" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r28">28.</a><div class="reference-content">Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma. III: family history, actinic damage and phenotypic factors. <i>Eur J Cancer</i>. 2005;41(14):2040-2059.</div></div><div class="reference"><a class="reference-number" id="doi220006r29">29.</a><div class="reference-content">Landi MT, Bishop DT, MacGregor S, et al; GenoMEL Consortium; Q-MEGA and QTWIN Investigators; ATHENS Melanoma Study Group; 23andMe; SDH Study Group; IBD Investigators; Essen-Heidelberg Investigators; AMFS Investigators; MelaNostrum Consortium. Genome-wide association meta-analyses combining multiple risk phenotypes provide insights into the genetic architecture of cutaneous melanoma susceptibility. <i xmlns:helper="urn:XsltStringHelper"> Nat Genet</i>. 2020;52(5):494-504. doi:<a href="http://dx.doi.org/10.1038/s41588-020-0611-8">10.1038/s41588-020-0611-8</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32341527" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Genome-wide%20association%20meta-analyses%20combining%20multiple%20risk%20phenotypes%20provide%20insights%20into%20the%20genetic%20architecture%20of%20cutaneous%20melanoma%20susceptibility.&author=MT%20Landi&author=DT%20Bishop&author=S%20MacGregor&publication_year=2020&journal=Nat%20Genet&volume=52&pages=494-504" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/s41588-020-0611-8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/s41588-020-0611-8" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r30">30.</a><div class="reference-content">Goldstein AM, Chan M, Harland M, et al; Melanoma Genetics Consortium (GenoMEL). High-risk melanoma susceptibility genes and pancreatic cancer, neural system tumors, and uveal melanoma across GenoMEL. <i xmlns:helper="urn:XsltStringHelper"> Cancer Res</i>. 2006;66(20):9818-9828. doi:<a href="http://dx.doi.org/10.1158/0008-5472.CAN-06-0494">10.1158/0008-5472.CAN-06-0494</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17047042" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=High-risk%20melanoma%20susceptibility%20genes%20and%20pancreatic%20cancer%2C%20neural%20system%20tumors%2C%20and%20uveal%20melanoma%20across%20GenoMEL.&author=AM%20Goldstein&author=M%20Chan&author=M%20Harland&publication_year=2006&journal=Cancer%20Res&volume=66&pages=9818-9828" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1158/0008-5472.CAN-06-0494" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1158/0008-5472.CAN-06-0494" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r31">31.</a><div class="reference-content">Zuo L, Weger J, Yang Q, et al. Germline mutations in the p16INK4a binding domain of CDK4 in familial melanoma. <i xmlns:helper="urn:XsltStringHelper"> Nat Genet</i>. 1996;12(1):97-99. doi:<a href="http://dx.doi.org/10.1038/ng0196-97">10.1038/ng0196-97</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8528263" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Germline%20mutations%20in%20the%20p16INK4a%20binding%20domain%20of%20CDK4%20in%20familial%20melanoma.&author=L%20Zuo&author=J%20Weger&author=Q%20Yang&publication_year=1996&journal=Nat%20Genet&volume=12&pages=97-99" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/ng0196-97" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/ng0196-97" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r32">32.</a><div class="reference-content">Valverde P, Healy E, Jackson I, Rees JL, Thody AJ. Variants of the melanocyte-stimulating hormone receptor gene are associated with red hair and fair skin in humans. <i xmlns:helper="urn:XsltStringHelper"> Nat Genet</i>. 1995;11(3):328-330. doi:<a href="http://dx.doi.org/10.1038/ng1195-328">10.1038/ng1195-328</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/7581459" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Variants%20of%20the%20melanocyte-stimulating%20hormone%20receptor%20gene%20are%20associated%20with%20red%20hair%20and%20fair%20skin%20in%20humans.&author=P%20Valverde&author=E%20Healy&author=I%20Jackson&author=JL%20Rees&author=AJ%20Thody&publication_year=1995&journal=Nat%20Genet&volume=11&pages=328-330" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/ng1195-328" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/ng1195-328" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r33">33.</a><div class="reference-content">Olsen CM, Thompson JF, Pandeya N, Whiteman DC. Evaluation of sex-specific incidence of melanoma. <i xmlns:helper="urn:XsltStringHelper"> JAMA Dermatol</i>. 2020;156(5):553-560. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2020.0470">10.1001/jamadermatol.2020.0470</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32211827" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Evaluation%20of%20sex-specific%20incidence%20of%20melanoma.&author=CM%20Olsen&author=JF%20Thompson&author=N%20Pandeya&author=DC%20Whiteman&publication_year=2020&journal=JAMA%20Dermatol&volume=156&pages=553-560" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamadermatol.2020.0470" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jamadermatol.2020.0470" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r34">34.</a><div class="reference-content">Bellenghi M, Puglisi R, Pontecorvi G, De Feo A, Carè A, Mattia G. Sex and gender disparities in melanoma. <i xmlns:helper="urn:XsltStringHelper"> Cancers (Basel)</i>. 2020;12(7):E1819. doi:<a href="http://dx.doi.org/10.3390/cancers12071819">10.3390/cancers12071819</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32645881" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Sex%20and%20gender%20disparities%20in%20melanoma.&author=M%20Bellenghi&author=R%20Puglisi&author=G%20Pontecorvi&author=A%20De Feo&author=A%20Carè&author=G%20Mattia&publication_year=2020&journal=Cancers%20%28Basel%29&volume=12&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3390/cancers12071819" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3390/cancers12071819" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r35">35.</a><div class="reference-content">Sung H, Siegel RL, Rosenberg PS, Jemal A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. <i xmlns:helper="urn:XsltStringHelper"> Lancet Public Health</i>. 2019;4(3):e137-e147. doi:<a href="http://dx.doi.org/10.1016/S2468-2667(18)30267-6">10.1016/S2468-2667(18)30267-6</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30733056" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Emerging%20cancer%20trends%20among%20young%20adults%20in%20the%20USA%3A%20analysis%20of%20a%20population-based%20cancer%20registry.&author=H%20Sung&author=RL%20Siegel&author=PS%20Rosenberg&author=A%20Jemal&publication_year=2019&journal=Lancet%20Public%20Health&volume=4&pages=e137-e147" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2468-2667(18)30267-6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S2468-2667(18)30267-6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r36">36.</a><div class="reference-content">MacKie RM, Bray C, Vestey J, et al; Scottish Melanoma Group. Melanoma incidence and mortality in Scotland 1979-2003. <i xmlns:helper="urn:XsltStringHelper"> Br J Cancer</i>. 2007;96(11):1772-1777. doi:<a href="http://dx.doi.org/10.1038/sj.bjc.6603801">10.1038/sj.bjc.6603801</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17533392" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Melanoma%20incidence%20and%20mortality%20in%20Scotland%201979-2003.&author=RM%20MacKie&author=C%20Bray&author=J%20Vestey&publication_year=2007&journal=Br%20J%20Cancer&volume=96&pages=1772-1777" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/sj.bjc.6603801" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/sj.bjc.6603801" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r37">37.</a><div class="reference-content">Glazer AM, Winkelmann RR, Farberg AS, Rigel DS. Analysis of trends in US melanoma incidence and mortality. <i xmlns:helper="urn:XsltStringHelper"> JAMA Dermatol</i>. 2017;153(2)225-226. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2016.4512">10.1001/jamadermatol.2016.4512</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/28002545" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Analysis%20of%20trends%20in%20US%20melanoma%20incidence%20and%20mortality.&author=AM%20Glazer&author=RR%20Winkelmann&author=AS%20Farberg&author=DS%20Rigel&publication_year=2017&journal=JAMA%20Dermatol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamadermatol.2016.4512" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jamadermatol.2016.4512" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r38">38.</a><div class="reference-content">Lindholm C, Andersson R, Dufmats M, et al; Swedish Melanoma Study Group. Invasive cutaneous malignant melanoma in Sweden, 1990-1999: a prospective, population-based study of survival and prognostic factors. <i xmlns:helper="urn:XsltStringHelper"> Cancer</i>. 2004;101(9):2067-2078. doi:<a href="http://dx.doi.org/10.1002/cncr.20602">10.1002/cncr.20602</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15372475" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Invasive%20cutaneous%20malignant%20melanoma%20in%20Sweden%2C%201990-1999%3A%20a%20prospective%2C%20population-based%20study%20of%20survival%20and%20prognostic%20factors.&author=C%20Lindholm&author=R%20Andersson&author=M%20Dufmats&publication_year=2004&journal=Cancer&volume=101&pages=2067-2078" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/cncr.v101:9" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/cncr.v101:9" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r39">39.</a><div class="reference-content">de Vries E, Coebergh JW. Cutaneous malignant melanoma in Europe. <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2004;40(16):2355-2366. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2004.06.003">10.1016/j.ejca.2004.06.003</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15519506" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cutaneous%20malignant%20melanoma%20in%20Europe.&author=E%20de Vries&author=JW%20Coebergh&publication_year=2004&journal=Eur%20J%20Cancer&volume=40&pages=2355-2366" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2004.06.003" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2004.06.003" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r40">40.</a><div class="reference-content">Allemani C, Matsuda T, Di Carlo V, et al; CONCORD Working Group. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. <i xmlns:helper="urn:XsltStringHelper"> Lancet</i>. 2018;391(10125):1023-1075. doi:<a href="http://dx.doi.org/10.1016/S0140-6736(17)33326-3">10.1016/S0140-6736(17)33326-3</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29395269" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Global%20surveillance%20of%20trends%20in%20cancer%20survival%202000-14%20%28CONCORD-3%29%3A%20analysis%20of%20individual%20records%20for%2037%E2%80%AF513%E2%80%AF025%20patients%20diagnosed%20with%20one%20of%2018%20cancers%20from%20322%20population-based%20registries%20in%2071%20countries.&author=C%20Allemani&author=T%20Matsuda&author=V%20Di Carlo&publication_year=2018&journal=Lancet&volume=391&pages=1023-1075" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S0140-6736(17)33326-3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/S0140-6736(17)33326-3" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r41">41.</a><div class="reference-content">Sacchetto L, Zanetti R, Comber H, et al. Trends in incidence of thick, thin and in situ melanoma in Europe. <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2018;92:108-118. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2017.12.024">10.1016/j.ejca.2017.12.024</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29395684" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20incidence%20of%20thick%2C%20thin%20and%20in%20situ%20melanoma%20in%20Europe.&author=L%20Sacchetto&author=R%20Zanetti&author=H%20Comber&publication_year=2018&journal=Eur%20J%20Cancer&volume=92&pages=108-118" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2017.12.024" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2017.12.024" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r42">42.</a><div class="reference-content">Sankaranarayanan R, Swaminathan R, eds. <i xmlns:helper="urn:XsltStringHelper"> Cancer Survival in Africa, Asia, the Caribbean and Central America</i>. International Agency for Research on Cancer/World Health Organization; 2011.</div></div><div class="reference"><a class="reference-number" id="doi220006r43">43.</a><div class="reference-content">Berk-Krauss J, Stein JA, Weber J, Polsky D, Geller AC. New systematic therapies and trends in cutaneous melanoma deaths among US whites, 1986-2016. <i xmlns:helper="urn:XsltStringHelper"> Am J Public Health</i>. 2020;110(5):731-733. doi:<a href="http://dx.doi.org/10.2105/AJPH.2020.305567">10.2105/AJPH.2020.305567</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32191523" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=New%20systematic%20therapies%20and%20trends%20in%20cutaneous%20melanoma%20deaths%20among%20US%20whites%2C%201986-2016.&author=J%20Berk-Krauss&author=JA%20Stein&author=J%20Weber&author=D%20Polsky&author=AC%20Geller&publication_year=2020&journal=Am%20J%20Public%20Health&volume=110&pages=731-733" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.2105/AJPH.2020.305567" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.2105/AJPH.2020.305567" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r44">44.</a><div class="reference-content">Mason R, Au L, Ingles Garces A, Larkin J. Current and emerging systemic therapies for cutaneous metastatic melanoma. <i xmlns:helper="urn:XsltStringHelper"> Expert Opin Pharmacother</i>. 2019;20(9):1135-1152. doi:<a href="http://dx.doi.org/10.1080/14656566.2019.1601700">10.1080/14656566.2019.1601700</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31025594" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Current%20and%20emerging%20systemic%20therapies%20for%20cutaneous%20metastatic%20melanoma.&author=R%20Mason&author=L%20Au&author=A%20Ingles Garces&author=J%20Larkin&publication_year=2019&journal=Expert%20Opin%20Pharmacother&volume=20&pages=1135-1152" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1080/14656566.2019.1601700" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1080/14656566.2019.1601700" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r45">45.</a><div class="reference-content">Whiteman DC, Baade PD, Olsen CM. More people die from thin melanomas (≤1 mm) than from thick melanomas (>4 mm) in Queensland, Australia. <i xmlns:helper="urn:XsltStringHelper"> J Invest Dermatol</i>. 2015;135(4):1190-1193. doi:<a href="http://dx.doi.org/10.1038/jid.2014.452">10.1038/jid.2014.452</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/25330295" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=More%20people%20die%20from%20thin%20melanomas%20%28%E2%89%A41%E2%80%89mm%29%20than%20from%20thick%20melanomas%20%28%3E4%E2%80%89mm%29%20in%20Queensland%2C%20Australia.&author=DC%20Whiteman&author=PD%20Baade&author=CM%20Olsen&publication_year=2015&journal=J%20Invest%20Dermatol&volume=135&pages=1190-1193" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/jid.2014.452" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/jid.2014.452" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r46">46.</a><div class="reference-content">Baade P, Meng X, Youlden D, Aitken J, Youl P. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990-2006. <i xmlns:helper="urn:XsltStringHelper"> Int J Cancer</i>. 2012;130(1):170-178. doi:<a href="http://dx.doi.org/10.1002/ijc.25996">10.1002/ijc.25996</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21344376" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Time%20trends%20and%20latitudinal%20differences%20in%20melanoma%20thickness%20distribution%20in%20Australia%2C%201990-2006.&author=P%20Baade&author=X%20Meng&author=D%20Youlden&author=J%20Aitken&author=P%20Youl&publication_year=2012&journal=Int%20J%20Cancer&volume=130&pages=170-178" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/ijc.25996" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1002/ijc.25996" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r47">47.</a><div class="reference-content">van der Leest RJ, Zoutendijk J, Nijsten T, et al. Increasing time trends of thin melanomas in The Netherlands: what are the explanations of recent accelerations? <i xmlns:helper="urn:XsltStringHelper"> Eur J Cancer</i>. 2015;51(18):2833-2841. doi:<a href="http://dx.doi.org/10.1016/j.ejca.2015.09.008">10.1016/j.ejca.2015.09.008</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26589973" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Increasing%20time%20trends%20of%20thin%20melanomas%20in%20The%20Netherlands%3A%20what%20are%20the%20explanations%20of%20recent%20accelerations%3F&author=RJ%20van der Leest&author=J%20Zoutendijk&author=T%20Nijsten&publication_year=2015&journal=Eur%20J%20Cancer&volume=51&pages=2833-2841" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ejca.2015.09.008" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ejca.2015.09.008" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r48">48.</a><div class="reference-content">Watson M, Geller AC, Tucker MA, Guy GP Jr, Weinstock MA. Melanoma burden and recent trends among non-Hispanic whites aged 15-49 years, United States. <i xmlns:helper="urn:XsltStringHelper"> Prev Med</i>. 2016;91:294-298. doi:<a href="http://dx.doi.org/10.1016/j.ypmed.2016.08.032">10.1016/j.ypmed.2016.08.032</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27565055" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Melanoma%20burden%20and%20recent%20trends%20among%20non-Hispanic%20whites%20aged%2015-49%20years%2C%20United%20States.&author=M%20Watson&author=AC%20Geller&author=MA%20Tucker&author=GP%20Guy&author=MA%20Weinstock&publication_year=2016&journal=Prev%20Med&volume=91&pages=294-298" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.ypmed.2016.08.032" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.ypmed.2016.08.032" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r49">49.</a><div class="reference-content">Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. <i xmlns:helper="urn:XsltStringHelper"> CA Cancer J Clin</i>. 2016;66(1):7-30. doi:<a href="http://dx.doi.org/10.3322/caac.21332">10.3322/caac.21332</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26742998" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cancer%20statistics%2C%202016.&author=RL%20Siegel&author=KD%20Miller&author=A%20Jemal&publication_year=2016&journal=CA%20Cancer%20J%20Clin&volume=66&pages=7-30" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3322/caac.21332" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3322/caac.21332" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r50">50.</a><div class="reference-content">Welch HG, Mazer BL, Adamson AS. The rapid rise in cutaneous melanoma diagnoses. <i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2021;384(1):72-79. doi:<a href="http://dx.doi.org/10.1056/NEJMsb2019760">10.1056/NEJMsb2019760</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33406334" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20rapid%20rise%20in%20cutaneous%20melanoma%20diagnoses.&author=HG%20Welch&author=BL%20Mazer&author=AS%20Adamson&publication_year=2021&journal=N%20Engl%20J%20Med&volume=384&pages=72-79" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMsb2019760" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1056/NEJMsb2019760" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r51">51.</a><div class="reference-content">Waldmann A, Nolte S, Weinstock MA, et al. Skin cancer screening participation and impact on melanoma incidence in Germany—an observational study on incidence trends in regions with and without population-based screening. <i xmlns:helper="urn:XsltStringHelper"> Br J Cancer</i>. 2012;106(5):970-974. doi:<a href="http://dx.doi.org/10.1038/bjc.2012.22">10.1038/bjc.2012.22</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22294187" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Skin%20cancer%20screening%20participation%20and%20impact%20on%20melanoma%20incidence%20in%20Germany%E2%80%94an%20observational%20study%20on%20incidence%20trends%20in%20regions%20with%20and%20without%20population-based%20screening.&author=A%20Waldmann&author=S%20Nolte&author=MA%20Weinstock&publication_year=2012&journal=Br%20J%20Cancer&volume=106&pages=970-974" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/bjc.2012.22" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/bjc.2012.22" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r52">52.</a><div class="reference-content">Brunssen A, Waldmann A, Eisemann N, Katalinic A. Impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence and mortality: a systematic review. <i xmlns:helper="urn:XsltStringHelper"> J Am Acad Dermatol</i>. 2017;76(1):129-139.e10. doi:<a href="http://dx.doi.org/10.1016/j.jaad.2016.07.045">10.1016/j.jaad.2016.07.045</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27707591" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Impact%20of%20skin%20cancer%20screening%20and%20secondary%20prevention%20campaigns%20on%20skin%20cancer%20incidence%20and%20mortality%3A%20a%20systematic%20review.&author=A%20Brunssen&author=A%20Waldmann&author=N%20Eisemann&author=A%20Katalinic&publication_year=2017&journal=J%20Am%20Acad%20Dermatol&volume=76&pages=129-139.e10" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jaad.2016.07.045" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.jaad.2016.07.045" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r53">53.</a><div class="reference-content">Herbert A, Koo MM, Barclay ME, et al. Stage-specific incidence trends of melanoma in an English region, 1996-2015: longitudinal analyses of population-based data. <i xmlns:helper="urn:XsltStringHelper"> Melanoma Res</i>. 2020;30(3):279-285. doi:<a href="http://dx.doi.org/10.1097/CMR.0000000000000489">10.1097/CMR.0000000000000489</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30106842" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Stage-specific%20incidence%20trends%20of%20melanoma%20in%20an%20English%20region%2C%201996-2015%3A%20longitudinal%20analyses%20of%20population-based%20data.&author=A%20Herbert&author=MM%20Koo&author=ME%20Barclay&publication_year=2020&journal=Melanoma%20Res&volume=30&pages=279-285" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/CMR.0000000000000489" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/CMR.0000000000000489" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r54">54.</a><div class="reference-content">Bray F, Guilloux A, Sankila R, Parkin DM. Practical implications of imposing a new world standard population. <i xmlns:helper="urn:XsltStringHelper"> Cancer Causes Control</i>. 2002;13(2):175-182. doi:<a href="http://dx.doi.org/10.1023/A:1014344519276">10.1023/A:1014344519276</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/11936824" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Practical%20implications%20of%20imposing%20a%20new%20world%20standard%20population.&author=F%20Bray&author=A%20Guilloux&author=R%20Sankila&author=DM%20Parkin&publication_year=2002&journal=Cancer%20Causes%20Control&volume=13&pages=175-182" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1023/A:1014344519276" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1023/A:1014344519276" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r55">55.</a><div class="reference-content">Bray F, Møller B. Predicting the future burden of cancer. <i xmlns:helper="urn:XsltStringHelper"> Nat Rev Cancer</i>. 2006;6(1):63-74. doi:<a href="http://dx.doi.org/10.1038/nrc1781">10.1038/nrc1781</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16372017" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Predicting%20the%20future%20burden%20of%20cancer.&author=F%20Bray&author=B%20Møller&publication_year=2006&journal=Nat%20Rev%20Cancer&volume=6&pages=63-74" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/nrc1781" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1038/nrc1781" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="doi220006r56">56.</a><div class="reference-content">Khair DO, Bax HJ, Mele S, et al. Combining immune checkpoint inhibitors: established and emerging targets and strategies to improve outcomes in melanoma. <i xmlns:helper="urn:XsltStringHelper"> Front Immunol</i>. 2019;10:453. doi:<a href="http://dx.doi.org/10.3389/fimmu.2019.00453">10.3389/fimmu.2019.00453</a> <a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30941125" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Combining%20immune%20checkpoint%20inhibitors%3A%20established%20and%20emerging%20targets%20and%20strategies%20to%20improve%20outcomes%20in%20melanoma.&author=DO%20Khair&author=HJ%20Bax&author=S%20Mele&publication_year=2019&journal=Front%20Immunol&volume=10&pages=453" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3389/fimmu.2019.00453" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.3389/fimmu.2019.00453" xmlns:helper="urn:XsltStringHelper"> </span></div></div></div> </div> </div> <div class="movable-ad bta"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_textbreak_bta_dual"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_textbreak_bta_dual" data-params="{"parameters":{"siteName":"jamadermatology","siteId":12,"journalId":68,"adDisplay":8,"adSection":"textbreak","adPosition":"bta","fromGoogle":false},"dynamicParameters":{}}"></div> </div> </div> </div> </div> <div class="hidden-jobs-ad hide"> <div class="widget-WidgetLoader widget-instance-AMA_JobsAd"> <div class="SCM-SharedWidgets-AsyncJobsAdLoader" data-url="/AMA/JobsAd/AMA_JobsAd" data-params="{"parameters":{"SiteId":12},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <script> var App = App || {}; App.ArticleSplitScreen = App.ArticleSplitScreen || {}; App.ArticleSplitScreen.siteName = 'jamadermatology'; App.ArticleSplitScreen.siteId = 12; App.ArticleSplitScreen.journalId = 68; App.ArticleSplitScreen.adDisplay = 'ArticleContentsSkyBox'; App.ArticleSplitScreen.adSection = "scholarly"; App.ArticleSplitScreen.adPosition = "contab"; App.ArticleSplitScreen.controlId = "AMA_AdTag_Contents_Skybox"; App.ArticleSplitScreen.fromGoogle = "False"; App.ArticleSplitScreen.slotLocationOverride = "50"; </script> </div> </div> </section> <section id="secFooterControl" class="master-footer"> <script> var App = App || {}; function scmByClass(className) { return document.getElementsByClassName(className); } function scmById(id) { return document.getElementById(id); } function scmquery(selector) { return document.querySelector(selector); } function queryAll(selector) { return document.querySelectorAll(selector); } function isTrueString(string) { if (typeof string === 'string') { return string.toLowerCase() === 'true'; } return undefined; } function updateViewportDimensions() { var w = window, d = document, e = d.documentElement, g = d.getElementsByTagName('body')[0], x = w.innerWidth || e.clientWidth || g.clientWidth, y = w.innerHeight || e.clientHeight || g.clientHeight; return { width: x, height: y }; } var viewport = updateViewportDimensions(); var debounce = function (func, wait, immediate) { var timeout; return function () { var context = this, args = arguments; var later = function () { timeout = null; if (!immediate) func.apply(context, args); }; var callNow = immediate && !timeout; clearTimeout(timeout); timeout = setTimeout(later, wait); if (callNow) func.apply(context, args); }; }; (function (App) { App.mobileUpperBreakpoint = 767; App.mobileAltBreakpoint = 640; App.mobileMinBreakpoint = 547; App.tabletUpperBreakpoint = 1023; function setVariables() { viewport = updateViewportDimensions(); App.isMobile = (viewport.width <= App.mobileUpperBreakpoint); App.isMobileAlt = (viewport.width <= App.mobileAltBreakpoint); App.isTablet = (viewport.width > App.mobileUpperBreakpoint && viewport.width <= App.tabletUpperBreakpoint); App.isTabletDown = (viewport.width <= App.tabletUpperBreakpoint); App.isDesktop = (viewport.width > App.tabletUpperBreakpoint); App.activeViewport = App.isMobile ? 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