Elsevier

Ophthalmology

Volume 114, Issue 12, December 2007, Pages 2309-2315.e2
Ophthalmology

Original article
Incidence of Uveal Melanoma in Europe

https://doi.org/10.1016/j.ophtha.2007.01.032Get rights and content

Purpose

To estimate incidence rates of uveal melanoma in Europe from 1983 to 1994.

Design

Incidence analysis of data from cancer registries adhering to the European Cancer Registry–based study on survival and care of cancer patients (EUROCARE) (cases diagnosed from 1983 to 1994).

Participants

Data of 6673 patients with ocular melanoma (as defined by International Classification of Diseases for Oncology morphology codes 8720 to 8780 [melanoma] and International Classification of Diseases 9 (ICD9) codes 190.0 [iris and ciliary body], 190.5 [retina], 190.6 [choroid], and 190.9 [unspecified ocular location]) from 33 cancer registries of 16 European countries.

Methods

Incidence rate ratios (IRRs) were obtained from a multilevel Poisson regression model.

Main Outcome Measures

Incidence rates and IRRs associated with demographic and geographic variables.

Results

Standardized incidence rates increased from south to north across registries, from a minimum of <2 per million in registries of Spain and southern Italy up to >8 per million in Norway and Denmark. The inclusion of tumors with unspecified ocular location (code 190.9) increased incidence rates in most United Kingdom registries, but not in the other geographic areas, where this code was seldom used for uveal melanomas. Incidence increased noticeably up to age 55 (IRR, 1.46 per 5 years; 95% confidence interval [CI], 1.36–1.57) but leveled off after age 75 (IRR, 0.99 per 5 years; 95% CI, 0.93–1.05), with intermediate levels midway (IRR, 1.18 per 5 years; 95% CI, 1.12–1.23). It was also higher in males (IRR, 1.22; 95% CI, 1.16–1.28). Rates were stable during the study period, but a cohort effect was evidenced, accounting for higher incidence rates in people born during the period 1910 to 1935 (P = 0.005). Incidence increased with latitude (P = 0.008), which explained most differences in rates among areas.

Conclusions

In this large series of uveal melanomas, we found stable incidence during the years 1983 to 1994. The north-to-south decreasing gradient supports the protective role of ocular pigmentation. European ophthalmologists should develop guidelines to standardize the coding of tumors treated conservatively using the ICD classification to improve the registration and surveillance of uveal melanoma by cancer registries.

Section snippets

Definitions and Inclusion Criteria

Cases were defined as patients with ocular melanoma, as identified by the International Classification of Diseases 9 (ICD9) topography codes 190.0 (iris and ciliary body), 190.5 (retina), and 190.6 (choroid) and by the International Classification of Diseases for Oncology morphology codes 8720 to 8780 (melanoma). Based on the suggestion of Stang et al,8 we also considered the inclusion of tumors with an unspecified location in rate computation—namely, code 190.9 (part unspecified).

Contributing

Number of Cases Included for Ocular Subsite

During the 12 years of the study (1983–1994), 7051 melanomas located in the eye, orbit, lacrimal gland, or unspecified ocular sites (codes 190.0–190.9) were recorded by the registries.

Uveal melanoma was the most common location, accounting for 5566 cases (78.9%), including 901 (12.8%) tumors located in the iris or ciliary body (190.0) and 4665 (66.1%) in the choroid or retina subsites (190.5, 190.6). Cases in other locations were 81 (1.1%) in the orbit (190.1), 4 (0.1%) in the lacrimal gland

Discussion

This study has provided data on the incidence of uveal melanoma in several European countries, which may be useful for local policy-making, based on data from cancer registries adhering to EUROCARE in the period 1983 to 1994.

Our study confirms at the European level some previous findings on the effect of demographic variables on uveal melanoma incidence. The pattern of the association of rates with age was similar to that reported in recent studies in the U.S.,7 as rates increased with age and

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    Manuscript no. 2006-833.

    Research supported by the EUROCARE-3 BIOMED-2 program, Brussels, Belgium (contract no. BMH4-CT98-3390); Compagnia di San Paolo, Torino, Italy; and European Community, Brussels, Belgium (grant no. SPC.2002303-DEP/01/19, “European Network of Cancer Registries: Survival of Adult Patients with Rare Tumors”). Dr Virgili’s work was partially supported by the Master of Epidemiology, University of Turin, Turin, Italy.

    For a list of the members of the Group, see “Appendix” (available at http://aaojournal.org).

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