Comparative analysis of incidence and clinical features of cutaneous malignant melanoma in Crete (Greece) and southern Germany (central Baden‐Württemberg)

Summary Background  Comparative analysis of the incidence rates and epidemiological features of cutaneous malignant melanoma (CMM) between different ethnic groups exposed to varying environmental factors is critical for consideration of the causes of CMM but can also be utilized in a public health approach to control of the disease. Objectives  To compare incidence rates and clinical features of CMM in a Greek and a central European population (central Baden‐Württemberg, Germany). Methods  Incident cases of CMM were traced in all hospitals of the island of Crete for the period 1999–2002. Age‐standardized incidence rates per 100 000 inhabitants per year for the European Standard Population were calculated based on the Cretan population statistics. A comparison was performed between the Cretan findings and those of southern Germany as registered by the hospital‐based Central Malignant Melanoma Registry, which likewise documents more clinical features than normally recorded by population‐based cancer registries. Results  Mean incidence rates in Crete for 1999–2002 were 4·01 per 100 000 inhabitants per year for males and 4·05 for females as compared with 10·6 for males and 11·1 for females in southern Germany. There were striking differences in the clinical characteristics of CMMs, with significantly higher tumour thickness in Crete (median 1·4 mm vs. 0·7 mm in southern Germany). Correspondingly, significantly more nodular melanomas were observed in Crete (29%) as compared with southern Germany (11%). Conclusions  Incidence of CMM in Crete, with about four cases per 100 000 inhabitants per year, is clearly higher than previously estimated, and there is an urgent necessity for earlier recognition of CMM in Crete. However, the incidence of CMM in southern Germany is much higher.