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Background: Queensland, Australia, had the world's highest incidence rates of invasive cutaneous melanoma in the 1970s. Purpose: The purpose of this study was to monitor trends in melanoma incidence in Queensland. Methods: We studied two time periods in which ascertainment was comparable. Results: In the 7.5 years up to 1987, the incidence of invasive melanoma in Queensland increased by more than one half in women (to 42.89 per 100000) and more than doubled in men (to 55.81 per 100000), with the most dramatic increase seen in men over age 50 years. This higher increase in men is a reversal of the previously higher rates in women. In

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Received January 27, 1992; revised June 1, 1992; accepted June 9, 1992. Supported by grants from the Queensland CanBROWN LM, BLAIR A, GIBSON R, ET AL: cer Fund, the Queensland Department of Health, Pesticide exposures and other agricultural and the National Health and Medical Research risk factors for leukemia among men in Iowa Council. and Minnesota. Cancer Res 50:6585-6591, We thank Dr. Ian Ring, Queensland Cancer 1990 Registry, for access to registry data; Queensland Musicco M, SANT M, MOLINARI S, ET AL: pathologists and laboratory staff for providing acA case-control study of brain gliomas and cess to their files; Ms. Philippa Youl and Ms. occupational exposure to chemical carAnna Chung for data quality control; and Mr. cinogens: The risk to farmers. Am J Ulrich Kehren, Ms. Lea Mangahas, and Ms. Ros Epidemiol 128:778-785, 1988 Paterson for database management. TRAVIS LB, GONZALEZ CL, HANKEY BF, ET R. MacLennan, A. C. Green, N. G. Martin, AL: Hodgkin's disease following nonQueensland Institute of Medical Research, BrisHodgkin's lymphoma. Cancer 69:2337- bane, Australia. 2342, 1992 G. R. C. McLeod, Queensland Melanoma ProjBRECHER M, BANKS PM: Hodgkin's disease ect, Princess Alexandra Hospital, Brisbane. variant of Richter's Syndrome. Report of 'Correspondence to: Robert MacLennan, M.B., eight cases. Am J Clin Pathol 93:333-339, B.S., Queensland Institute of Medical Research, 1990 300 Herston Rd., Brisbane, Qld., Australia 4029.

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(17) GREENE MH, WILSON J: Second cancer fol-

Increasing Incidence of Cutaneous Melanoma in Queensland, Australia

If the worldwide incidence of cutaneous melanoma continues to rise at the same rapid rate observed over the last four decades, it is likely that the incidence of melanoma will overtake that of lung, bowel, and breast cancers in White populations early in the 21st century. Among cancer registries in six continents reporting for the period up to 1982 (7), the highest incidence rates of cutaneous melanoma in both males and females were in Queensland, Australia, followed by the "White" population of Hawaii and then by other populations within Australia and New Zealand. In this study, we report on new population-based trends in melanoma incidence in Queensland that demonstrate an extraordinary increase in melanoma incidence. We present incidence rates for preinvasive and invasive disease according to the histological classification and the thickness of the lesions.

Methods The Queensland Cancer Registry was established in 1982 and has reported cancer incidence up to 1985. A project was established in 1989 to more rapidly 1428

monitor melanoma incidence and to as- oratories were unaware that lentigo masess the completeness of melanoma-case ligna alone is notifiable. A large number notification to the Queensland Cancer of lesions in the 1987 study coded as Registry by pathology laboratories. Be- "melanoma not otherwise specified" cause records were readily available in (ICD-0 group 8720/3) would have been laboratories, the calendar year 1987 was distributed among other McGovern (3) selected initially for study and is com- categories in the 1979/1980 study. Perpared here with a similar survey of all sons with more than one primary laboratories over a 12-month period in melanoma were excluded when a previous primary melanoma was known; 1979 and 1980. this situation was more likely to occur Case Ascertainment for the 1987 study than for the 1979/1980 study due to the ability in Pathology reports for all primary cu1987 to cross-check against previous taneous melanomas (International Clasnotification to the Queensland Cancer sification of Diseases, 9th revision, site Registry. Measured thickness of invascodes 172.0-172.9 and 232.0-232.9) diive lesions (5) was recorded in the paagnosed between July 1, 1979, and June thology reports of 91% of the males and 30, 1980, were gathered from 24 govof 90% of the females and has been ernment, hospital, and private pathology grouped for analysis. laboratories throughout Queensland, Only persons who resided in Queenslargely during personal visits by A. C. land were included. Although it was imGreen to each laboratory (2). In Queenspossible to distinguish aboriginal land, it is extremely rare for a clinically Australians who constitute approxdiagnosed cutaneous melanoma not to imately 2% of the Queensland populabe examined histologically. Our qualitytion, melanoma has rarely been recorded control procedures for the 1987 study in aborigines. Population denominators included verification of notification by were from the Australian Bureau of Stacomparing pathology laboratory indexes tistics for June 1980 and June 1986 and written reports of all melanomas di(census year). Directly age-standardized agnosed in 1987 with lists of all cases in the Queensland Cancer Registry. All rates and their confidence limits (using major laboratories were visited, and the binomial approximation method to other laboratories with only a few cases calculate standard errors) were calcuprovided lists from their indexes. Infor- lated as described by Boyle and Parkin mation from pathology reports of 111 (6). The cumulative rates and risks were previously unregistered cases compris- calculated according to Day (7); for this ing 58 lentigo maligna and 53 superfi- calculation, estimates of cumulative risk cial spreading melanomas was thus for persons aged 0-74 years are approxiadded to the Queensland Cancer Regis- mated from the cumulative rate, and the try 1987 melanoma data. Missing regis- effects of other diseases, such as those try data on melanoma morphology occurring in middle age, are ignored. among 140 cases were obtained in 120 All incidence rates for 1979/1980 and cases by visits to hospital medical rec- 1987 were age standardized to the standard world population (6), and inords departments. vasive melanoma was also age standardized to the U.S. population of 1970 (8). Pathology Pathology was coded for 1979/1980 during visits to data sources according to McGovern (3); for 1987, pathology reports were coded according to the first edition of the International Classification of Disease for Oncology (ICD-O) (4). Although the code 8742/2 is used for lentigo maligna (Hutchinson's melanotic freckle) whether or not melanoma is also diagnosed, we have added a code to allow more valid future analysis of time trends, since some lab-

Results Total Melanoma In a comparison of two 12-month periods, 7.5 years apart, the total incidence of melanoma in Queensland, age standardized to the world population, almost doubled in males and increased by 50% in females in 1987 compared with that in 1979/1980 (Table 1). By 1987, cumulative risks (in persons aged 0-74 Journal of the National Cancer Institute

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Queensland, cumulative risks of total cutaneous melanoma (in persons aged 0-74 years), including preinvasive melanoma, have increased to one in 14 in men and to one in 17 in women. There were large increases in agestandardized incidence rates of thin lesions (