Jou nal P e-p oo
E ol ing landscape o melanoma in Po ugal, Spain, I aly, and G eece:
ends and insigh s
L. Cayuela J.J. Pe ey a-Rod ´
ıguez J.C. He n´
andez-Rod ´
ıguez R.C.
Bueno-Molina A. Cayuela
PII: S0001-7310(25)00095-X
DOI: h ps://doi.o g/doi:10.1016/j.ad.2024.10.062
Re e ence: AD 4265
To appea in: Ac as de mosifiliog aficas
Recei ed Da e: 7 Augus 2024
Accep ed Da e: 21 Oc obe 2024
Please ci e his a icle as: Cayuela L, Pe ey a-Rod ´
ıguez JJ, He n´
andez-Rod ´
ıguez JC,
Bueno-Molina RC, Cayuela A, E ol ing landscape o melanoma in Po ugal, Spain, I aly, and
G eece: ends and insigh s, Ac as de mosifiliog aficas (2025),
doi: h ps://doi.o g/10.1016/j.ad.2024.10.062
This is a PDF file o an a icle ha has unde gone enhancemen s a e accep ance, such as
he addi ion o a co e page and me ada a, and o ma ing o eadabili y, bu i is no ye he
defini i e e sion o eco d. This e sion will unde go addi ional copyedi ing, ypese ing and
e iew be o e i is published in i s final o m, bu we a e p o iding his e sion o gi e ea ly
isibili y o he a icle. Please no e ha , du ing he p oduc ion p ocess, e o s may be
disco e ed which could a ec he con en , and all legal disclaime s ha apply o he jou nal
pe ain.
© 2025 AEDV. Published by Else ie España, S.L.U.
Page 1 o 18
Jou nal P e-p oo
1
Sección: A ículo o iginal
E ol ing landscape o melanoma in Po ugal, Spain, I aly, and G eece: ends and insigh s
Pano ama ac ual del melanoma en Po ugal, España, I alia y G ecia: endencias y pe spec i as
Sho i le: Melanoma mo ali y in Sou he n Eu ope
Au ho s:
L. Cayuela1
J. J. Pe ey a-Rod íguez2,3
J.C. He nández-Rod íguez3
R. C. Bueno-Molina3
A. Cayuela4
1. Depa men o In e nal Medicine, Hospi al Se e o Ochoa, Leganés, Spain
2. Depa men o Medicine, Uni e si y o Se ille, Se ille, Spain.
3. Depa men o De ma ology, Vi gen del Rocío Uni e si y Hospi al, Se ille, Spain.
4. Uni o Public Heal h, P e en ion and Heal h P omo ion. Sou h Se ille Heal h Managemen
A ea. Se ille, Spain
Co esponding au o :
José-Juan Pe ey a-Rod íguez,
E-mail add ess: jpe ey [email p o ec ed]
Page 2 o 18
Jou nal P e-p oo
2
G aphical Abs ac
Abs ac
Objec i e: To s udy melanoma incidence ends om 1990 h ough 2021 in Sou he n Eu opean
coun ies—Po ugal, Spain, I aly, G eece—and explo e egional and age-pe iod-coho (A-P-C)
pa e ns.
Me hods: Da a om he Global Bu den o Disease S udy 2021 we e used o calcula e age-
s anda dized incidence a es (ASIRs). Joinpoin eg ession and age-pe iod coho (A-P-C) models we e
applied o iden i y ends and pa e ns.
Page 3 o 18
Jou nal P e-p oo
3
Resul s: A subs an ial inc ease in melanoma ASIRs was obse ed ac oss all Sou he n Eu opean
coun ies om 1990 h ough 2021. Joinpoin analysis e ealed a po en ial u ning poin in he 2010s,
wi h ASIRs s abilizing o declining in younge age g oups ac oss all coun ies. Fo ins ance, a es
among younge women in I aly, Po ugal, and Spain ha e shown signs o s abiliza ion o decline, while
G eek women expe ienced a con inued bu slowe inc ease. Men exhibi ed a simila end, excep o
G eece, whe e he inc ease a e pe sis ed albei a a slowe pace. Gende di e ences we e e iden ,
wi h younge women gene ally acing highe isks s men bu exhibi ing a slowe ise in incidence
wi h age.
The A-P-C analysis con i med a p onounced coho e ec , indica ing a highe isk o melanoma
among ea lie bi h coho s. Among younge gene a ions, he e is e idence o s abiliza ion o e en a
decline in incidence a es.
Conclusion: Melanoma a es a e ising in Sou he n Eu ope, especially among men. While
younge popula ions show p omising declines, likely due o sun p o ec ion e o s, olde gene a ions
con inue o be a ec ed. Add essing egional dispa i ies and sus aining hese posi i e ends equi es
ongoing e o s and comp ehensi e p e en ion s a egies.
Keywo ds: Melanoma, Incidence ends, Sou he n Eu ope, Public heal h, age-pe iod-coho
Analysis
Resumen
Obje i o: Analiza las endencias en la incidencia del melanoma den e 1990 a 2021 en los países del
su de Eu opa (Po ugal, España, I alia, G ecia) y los pa ones egionales y de Edad-pe íodo-coho e (A-
P-C).
Mé odos: Se u iliza on da os del “Global Bu den o Disease S udy 2021 “ pa a calcula las asas de
incidencia es anda izadas po edad (ASIR). Se aplica on modelos de eg esión de cambio de endencia
y de A-P-C pa a iden i ica endencias y pa ones.
Resul ados: Se obse ó un aumen o sus ancial de las ASIR de melanoma en odos los países del su de
Eu opa en e 1990 a 2021. El análisis de endencia e eló un posible pun o de in lexión en la década
de 2010, con una es abilización o disminución de las ASIR en los g upos de edad más jó enes en odos
los países. Las asas en e las muje es más jó enes en I alia, Po ugal y España han mos ado signos de
es abilización o disminución, mien as que las muje es g iegas expe imen a on un aumen o con inuo
pe o más len o. Los homb es mos a on una endencia simila , excep o en G ecia, donde la asa de
aumen o pe sis ió, aunque a un i mo más len o. Las di e encias de géne o ue on e iden es: las
muje es más jó enes gene almen e p esen an un iesgo mayo en compa ación con los homb es, pe o
mues an un aumen o más len o en la incidencia con la edad.
El análisis A-P-C con i mó un e ec o de coho e p onunciado, lo que indica un mayo iesgo de
melanoma en e las coho es de nacimien o an e io es. En e las gene aciones más jó enes, hay
e idencia de es abilización o incluso una disminución en las asas de incidencia.
Page 4 o 18
Jou nal P e-p oo
4
Conclusión: Las asas de melanoma es án aumen ando en el su de Eu opa, especialmen e en e los
homb es. Si bien las poblaciones más jó enes mues an disminuciones p ome edo as, p obablemen e
debido a los es ue zos de p o ección sola , las gene aciones mayo es con inúan iéndose a ec adas.
Abo da las dispa idades egionales y man ene es as endencias posi i as equie e es ue zos
con inuos y es a egias de p e ención in eg ales.
Palab as cla e: Melanoma, Tendencias de incidencia, Su de Eu opa, Salud pública, Análisis edad-
pe iodo-coho e
In oduc ion
Melanoma, he deadlies o m o skin cance , poses a signi ican and g owing global heal h
h ea , pa icula ly o ai -skinned popula ions1,2. Wi h o e 331,000 new cases and 58,000 dea hs
epo ed wo ldwide in 20223, he bu den o melanoma a exceeds ha o o he skin cance s4. This
ala ming end is p ima ily d i en by inc eased exposu e o ul a iole (UV) adia ion om sou ces such
as sunba hing and indoo anning5.
His o ically, Caucasian popula ions ha e expe ienced a d ama ic ise in melanoma incidence due
o bi h coho e ec s, which e e s o di e ences in isk among people bo n in di e en yea s.
Howe e , encou aging ends ha e eme ged in egions such as Oceania, No h Ame ica, and pa s o
Eu ope, whe e melanoma a es ha e s abilized o declined, especially among younge age g oups6.
These posi i e changes a e likely a ibu ed o e ec i e public heal h campaigns p omo ing sun
p o ec ion.
Eu ope exhibi s subs an ial egional dispa i ies in melanoma incidence. While no hwes e n
coun ies wi nessed a sha p inc ease un il he 1980s ollowed by s abiliza ion o decline, pa icula ly in
he 1930-1940 bi h coho 7, Sou he n Eu ope con inue o g apple wi h ising a es. This conce ning
end in coun ies such as Spain and I aly is associa ed wi h sunny clima es, gene ic ac o s, and li es yle
in luences 8–10. Ne e heless, excep ions o his pa e n exis . Fo ins ance, Ca alonia epo ed a decline
in melanoma incidence among young adul s du ing he ea ly 2000s11, and simila ends we e obse ed
in Emilia-Romagna (I aly) among women bo n a e 196112. A ecen I alian s udy u he suppo s
hese indings, indica ing a shi in melanoma isk s a ing wi h indi iduals bo n in he 1970s10.
To enhance ou unde s anding o melanoma incidence ends in Sou he n Eu ope, we conduc ed
a comp ehensi e s udy examining da a om Po ugal, Spain, I aly, and G eece om 1990 h ough 2021.
Ou esea ch aims o cha ac e ize he o e all melanoma incidence ajec o y in hese coun ies and
explo e he impac o he e ec s o he age-pe iod-coho analysis on hese pa e ns. Age e ec s
cap u e changes in melanoma isk associa ed wi h ageing, pe iod e ec s e lec changes occu ing a
speci ic poin s in ime (eg, due o public heal h in e en ions), and coho e ec s ep esen di e ences
be ween people bo n in di e en yea s.
Me hods
Page 5 o 18
Jou nal P e-p oo
5
Da a sou ces
Melanoma incidence and co esponding popula ion da a o Po ugal, Spain, I aly, and G eece
om 1990 h ough 2021 we e e ie ed om he Global Heal h Da a Exchange (GHDx) pla o m, a
esou ce o he Ins i u e o Heal h Me ics and E alua ion (IHME) con ibu ing o he Global Bu den o
Disease (GBD) S udy 2021 (h p://ghdx.heal hda a.o g/gbd- esul s- ool, accessed July 21, 2024)13. As
ou lined in p e ious GBD epo s2,14, he s udy d aws on da a om i al egis a ion sys ems, disease
egis ies, and li e a u e sea ch om epu able da abases like na ional cance egis ies and Cance
Incidence in Fi e Con inen s. These sou ces a e ecognized o hei eliabili y and a e egula ly upda ed
o ensu e accu a e cance es ima es. Melanoma cases we e iden i ied using he In e na ional
Classi ica ion o Diseases (ICD) codes: ICD-10 (C43-C43.9, Z85.82-Z85.828) and ICD-9 (172-172.9). This
coding scheme is consis en wi h ha used in p e ious s udies using he same da abase2,8. Da a we e
u he s a i ied by age and sex o enable comp ehensi e analysis by coun y.
S a is ical analysis
We es ima ed age-s anda dized incidence a es (ASIRs) s a i ied by sex and age g oups: < 35
yea s, 35-64 yea s, > 64 yea s, and all ages combined. This s anda diza ion—calcula ed using he di ec
me hod wi h he 2013 Eu opean S anda d Popula ion15—adjus s o di e ences in age dis ibu ion
ac oss popula ions, ensu ing alid compa isons.
We used he Joinpoin Reg ession P og am ( e sion 5.2.0.0) om he Na ional Cance Ins i u e
(h ps://su eillance.cance .go /joinpoin /) o analyze ends. This p og am iden i ies po en ial u ning
poin s (joinpoin s) in da a and calcula es he annual pe cen change (APC) o each esul ing end
segmen . I also de e mines he a e age annual pe cen change (AAPC) o he en i e s udy pe iod
(1990-2021). Addi ionally, we employed he "pai wise compa ison" op ion o assess i ends di e ed
signi ican ly be ween men and women. S a is ically signi ican ends (p < 0.05) a e epo ed as
"inc eases" o "dec eases"; non-signi ican ends a e desc ibed as "s able" o showing "no change."
All epo ed a es a e p esen ed pe 100,000 indi iduals, and he male- o- emale a io was calcula ed.
To u he unde s and he d i e s o obse ed ends, we implemen ed an age-pe iod coho (A-
P-C) model. This model dis inguishes he independen e ec s o age a diagnosis, calenda pe iod o
diagnosis, and bi h coho on melanoma incidence. Due o po en ial a e ins abili y, indi iduals
younge han 15 yea s and olde han 84 yea s we e excluded om he analysis. We ca ego ized da a
in o 6 5-yea pe iods (1992-1996 o 2017-2021), 16 5-yea age g oups (15-19 o 90-94 yea s), and 21
bi h coho s (1902-2002) based on he cen al yea o bi h. Age-speci ic incidence a e ma ices o
each age g oup and pe iod we e c ea ed using he Na ional Cance Ins i u e's A-P-C so wa e sui e
(h ps://analysis ools.cance .go /apc/). Key pa ame e s es ima ed by he model include longi udinal
age-speci ic a es, and a e a ios (RRs) o pe iod and coho e ec s ela i e o he e e ence ca ego ies
Page 6 o 18
Jou nal P e-p oo
6
(cen al age g oup, calenda pe iod, and bi h coho ). S a is ical signi icance was assessed using he
Wald chi-squa e es (α = 0.05).
E hical conside a ions
This s udy u ilized anonymized da a om publicly a ailable sou ces, agg ega ed by age g oup.
Since da a did no con ain any pe sonal iden i ie s and was publicly a ailable, in o med consen om
pa ien s was deemed unnecesa y. This app oach ully complied wi h he Guidelines o Accu a e and
T anspa en Heal h Es ima es Repo ing (GATHER)16.
Resul s
Tables 1 and 2 p esen ASIRs o melanoma o G eece, I aly, Po ugal, and Spain s a i ied by sex
and age g oup. ASIRs inc eased consis en ly ac oss all coun ies, age g oups, and sexes om 1990
h ough 2021. Howe e , he a e o inc ease a ied subs an ially.
Po ugal expe ienced he slowes o e all inc ease, wi h women showing a 1.7% annual ise and
men a 2.2% inc ease. I aly exhibi ed he mos apid g ow h, wi h women's a es inc easing by 3.3%
annually and men's by 3.2%. While melanoma incidence ose signi ican ly o e all, pa icula ly among
olde age g oups, he joinpoin analysis e ealed mo e complex ends h oughou ime.
Fo women o all ages, ASIRs exhibi ed a no iceable shi a ound he ea ly 2010s. Following an
ini ial inc ease, a es s abilized in G eece bu declined in I aly, Po ugal, and Spain. A simila end was
obse ed o men, excep o G eece, whe e a es con inued o ise, albei a a slowe pace. Among
indi iduals younge han 35 yea s, ASIRs changed a ound he la e 2000s o ea ly 2010s. Ra es ini ially
ose bu hen slowed o Po uguese and Spanish women. Fo Po uguese and Spanish men, a es
s abilized, while bo h sexes in G eece and I aly saw a dec ease. In he 35-64 age g oup, ASIRs—which
had been inc easing—began o s abilize in G eece du ing he 2010s. Con e sely, a es declined o bo h
sexes in I aly, Po ugal, and Spain. Fo hose aged 65 and olde , ASIRs also shi ed a ound he 2010s.
Ra es s abilized among I alian, Po uguese, and Spanish women, as well as I alian men. Howe e ,
Po uguese and Spanish men expe ienced declines, while G eek men showed a ma ked inc ease. G eek
women con inued o see a slowe a e o inc ease.
Figu e 1 shows he longi udinal age cu es o melanoma incidence in G eece, I aly, Spain and
Po ugal, s a i ied by sex. The isk o melanoma inc eases s eadily wi h age in bo h sexes, peaking in
he 80+ age g oup. The e a e ma ked di e ences ac oss hese Medi e anean coun ies. In younge age
g oups (up o 45 yea s), women gene ally ha e sligh ly highe melanoma incidence a es han men.
This end e e ses wi h age, as men show a s eepe inc ease in incidence a es. I aly has he highes
o e all a es, pa icula ly in men, wi h a signi ican inc ease om he 20-24 age g oup (2.1 pe 100,000),
peaking a 148.5 pe 100,000 in he oldes age g oup. I alian women also ha e highe a es han o he
coun ies.
Page 7 o 18
Jou nal P e-p oo
7
Al hough Po ugal has he lowes ini ial a es o bo h sexes in he younge age g oups, hese
a es inc ease signi ican ly in he olde popula ion, eaching 101.3 pe 100,000 o women and 113.0
pe 100,000 o men in he 90-94 age g oup. Spain ollows a simila pa e n, wi h high a es
concen a ed in he olde age g oups. In women, he a e ises om 0.5 pe 100,000 in he younges
age g oup up o 72.6 pe 100,000 in he oldes . In men, he a e peaks a 153.3 pe 100,000, he highes
o he ou coun ies.
Figu e 2 shows he es ima ed RRs o melanoma incidence o men and women by bi h coho .
Da a show signi ican a ia ion in melanoma RRs h oughou ime and be ween sexes. Al hough he RR
has inc eased o bo h sexes in ea lie bi h coho s i has s abilized in mo e ecen coho s. In
pa icula , he isk o women in G eece (bo n om he 1980s onwa ds) eached an ea lie pla eau
compa ed o I aly (bo n om he 1970s onwa ds) and Spain (bo n om he 1990s onwa ds). Only in
G eece is he isk s ill inc easing o women. Fo men, a simila s abiliza ion end can be obse ed since
he 1990s in G eece, Spain and Po ugal, while he isk con inues o g ow in I aly.
Figu e 3 shows he empo al ends in RRs o melanoma incidence in G eece, I aly, Spain, and
Po ugal, s a i ied by sex. Bo h men and women in Sou he n Eu ope expe ienced a s eady inc ease in
melanoma incidence o e he 30-yea s udy pe iod. Howe e , his upwa d end s abilized in he las
decade (2012-2021) o bo h sexes.
Discussion
Ou s udy e eals a subs an ial inc ease in ASIRs o melanoma ac oss Sou he n Eu ope (G eece,
I aly, Po ugal, and Spain) om 1990 h ough 2021, e lec ing global ends in melanoma incidence1,17.
This ise has been a ibu ed o inc eased sun exposu e and ad ancemen s in ea ly de ec ion due o
imp o ed diagnos ic ools and g ea e public awa eness18,19.
Encou agingly, ou indings indica e a po en ial u ning poin , wi h melanoma incidence
s abilizing o declining in younge age g oups in Sou he n Eu ope. This end mi o s he e e sal
obse ed in No he n Eu ope and highligh s he e ec i eness o sun sa e y campaigns. Adap ing
success ul s a egies om No he n Eu ope o he unique social and cul u al con ex s o Sou he n
Eu ope could po en ially eplica e hese posi i e ou comes.
Public heal h ini ia i es p omo ing sun p o ec ion likely con ibu e o he obse ed decline in
melanoma a es among younge popula ions. Howe e , li es yle changes (eg, inc eased indoo
ac i i ies) and demog aphic ac o s (eg, immig a ion pa e ns) migh also in luence hese ends10.
Howe e , he sus ained inc ease in melanoma among olde popula ions highligh s he long- e m
impac o pas sun exposu e1.
Melanoma incidence has s abilized o declined among pos -1970s women in G eece, I aly, and
Spain, while G eek men con inue o expe ience inc easing a es. Simila sex-speci ic pa e ns a e
Page 8 o 18
Jou nal P e-p oo
8
obse ed ac oss o he Medi e anean coun ies20. Gi en he p ima y ole o excessi e sun exposu e in
melanoma de elopmen among ai -skinned indi iduals, hese ends may pe sis in younge coho s,
po en ially leading o o e all incidence s abiliza ion o educ ion. Howe e , he sus ainabili y o hese
ends emains unce ain and equi es ongoing su eillance.
Age- ela ed melanoma incidence is signi ican ly s eepe o men s women in G eece, I aly, and
Spain. In con as , Po ugal shows a simila age- ela ed inc ease in melanoma incidence o bo h sexes.
Gende -speci ic di e ences a e e iden , wi h younge women gene ally acing highe isks, while men
expe ience a mo e p onounced inc ease wi h age27. I aly s ands ou wi h he highes o e all melanoma
a es and a widening gende gap in olde age g oups. G eece also exhibi s a no able gende dispa i y.
Con e sely, Po ugal and Spain epo highe melanoma a es among men, hough he gende
di e ences a e less p onounced. These a ia ions likely e lec a complex in e play o en i onmen al,
beha iou al, and social ac o s, including sun exposu e pa e ns, occupa ional haza ds, ho monal
in luences, and cul u al a i udes owa ds anning.
Unlike No he n Eu ope, whe e melanoma a es doubled e e y 10-20 yea s since he 1970s
be o e s abilizing in he mid-1990s7, Sou he n and Eas e n Eu ope ha e con inued o expe ience ising
melanoma a es20,21. This delay in s abiliza ion sugges s ha public heal h in e en ions in hese egions
may ha e been less e ec i e o slowe o ake e ec .
Ou indings align wi h p e ious esea ch showing an inc eased melanoma isk in successi e bi h
coho s h oughou Eu ope, wi h e idence o pe iod-speci ic s abiliza ion o decline in incidence
a es6,20, mi o ing ea lie No he n Eu opean ends28.
Ou s udy e eals signi ican egional dispa i ies in melanoma incidence in Sou he n Eu ope,
in luenced by ac o s beyond sun exposu e. Socioeconomic condi ions, including heal h ca e access
and G oss Domes ic P oduc , play a c ucial ole. P e ious esea ch has demons a ed a di ec
co ela ion be ween GDP and melanoma mo ali y a es22, wi h I aly and Spain exhibi ing highe GDP
and melanoma incidence s Po ugal and G eece. Addi ionally, cul u al a i udes owa ds anning and
sun exposu e pa e ns con ibu e o hese a ia ions. Despi e ex ensi e e o s o egula e and educa e
he public abou indoo anning, i s p e alence emains subs an ial, wi h I aly and Spain epo ing a es
o 20.5% and 19.3%, espec i ely, while G eece and Po ugal show lowe a es o 3% and 2.0%23.
In I aly, sunbed use a ies signi ican ly by egion, wi h No he n egions exhibi ing highe use
(22%) s cen al (17%) and sou he n egions (6%)24. These dispa i ies likely e lec di e ences in
legisla ion, clima e, cul u al a i udes, and misconcep ions abou sunbeds, such as hei pu po ed
bene i s o p e-holiday anning, acne ea men , and i amin D supplemen a ion25.
Combining educa ion wi h egula ion is c ucial o educe indoo anning, especially among high-
isk g oups. The s a k con as in sunbed use be ween Spain (19.3%) and Po ugal (2%) unde sco es he
po en ial impac o public awa eness campaigns. The in ol emen o Po ugal in he PROSAFE ini ia i e
Page 15 o 18
Jou nal P e-p oo
15
Figu e 2: Melanoma Incidence Ra e Ra ios by Bi h Coho , Sex, and Coun y.
Page 16 o 18
Jou nal P e-p oo
16
Figu e 3: Pe iod T ends in Melanoma Incidence Ra e Ra ios by Sex and Coun y
Page 17 o 18
Jou nal P e-p oo
17
Table 1: T ends in age-s anda dized incidence a es (ASIR) o melanoma in women ac oss G eece,
I aly, Po ugal, and Spain (1990-2021)
ASIR
T end #1
T end #2
T end #3
T end #4
Age-
G oup
1990
2021
AAPC
Pe iod
APC
Pe iod
APC
Pe iod
APC
Pe iod
APC
G eece
All
6.2
11.9
2.1*
1990-2003
4.0*
2003-2014
1.6*
2014-2017
-3.3
2017-2021
1.4
<35
1.8
2.5
0.9*
1990-2009
3.4*
2009-2021
-3*
35-64
6.7
14.6
2.5*
1990-2005
4*
2005-2014
2.9*
2014-2017
-4.1
2017-2021
1.3
65+
14.1
25.8
1.9*
1990-2001
4.3*
2001-2012
0.8*
2012-2016
-1.7
2016-2021
1.8*
I aly
All
11.0
17.6
3.3*
1990-1997
5.3*
1997-2013
2.0*
2013-2021
-2.0*
<35
3.7
4.8
0.9*
1990-1997
8.4*
1997-2013
0.9*
2013-2021
-5.3*
35-64
14.1
22.4
1.7*
1990-2000
4.7*
2000-2006
1.2
2006-2010
4.8*
2010-2021
-
1.8*
65+
19.3
34.0
2.1*
1990-1999
4.1*
1999-2003
-1.5
2003-2012
3.6*
2012-2021
0.1
Po ugal
All
4.2
11.6
1.7*
1990-1998
7.0*
1998-2002
1.9
2002-2011
5.1*
2011-2021
-
0.5*
<35
1.1
2.3
2.7*
1990-1997
6.5*
1997-2021
1.6*
35-64
4.9
13.6
3.5*
1990-1997
7.8*
1997-2004
3.1*
2004-2010
6.7*
2010-2021
-
0.5*
65+
9.3
26.5
3.4*
1990-1995
7.9*
1995-2012
4.3*
2012-2021
-0.5
Spain
All
7.2
14.5
2.6*
1990-1996
6.5*
1996-2014
2.4*
2014-2021
-1.8*
<35
1.6
3.2
2.3*
1990-1995
8.1*
1995-2021
1.2*
35-64
8.1
17.1
2.4*
1990-1994
10.2*
1994-2007
3.5*
2007-2015
1.2
2015-2021
-
3.1*
65+
17.1
32.1
1.9*
1990-2014
2.8*
2014-2021
-1.2
*: p < 0.05; AAPC: a e age annual pe cen change; APC: a e age pe cen change; ASIR: age-s anda dized incidence
a es
Table 2: T ends in age-s anda dized incidence a es (ASIR) o melanoma in men ac oss G eece, I aly,
Po ugal, and Spain (1990-2021)
ASIR
T end #1
T end #2
T end #3
T end #4
Age-
G ou
p
199
0
202
1
AAP
C
Pe iod
APC
Pe iod
APC
Pe iod
APC
Pe iod
APC
G eece
All
4.9
13.9
3.3*
1990-
2009
5.1
*
2009-
2021
0.5*
<35
0.9
1.9
2.0*
1990-
1994
9.8
*
1994-
2003
2.7*
2003-
2009
7.5*
2009-
2021
-
3.5*
Page 18 o 18
Jou nal P e-p oo
18
35-64
5.3
14.6
3.3*
1990-
2009
5.6
*
2009-
2021
-0.2
65+
12.2
37.1
3.6*
1990-
2003
5.4
*
2003-
2013
3.2*
2013-
2021
1.1*
I aly
All
10.3
21.7
3.2*
1990-
1998
6.0
*
1998-
2009
3.3*
2009-
2016
1.4*
2016-
2021
-
2.7*
<35
2.1
3.4
1.8*
1990-
1997
7.5
*
1997-
2011
2.7*
2011-
2021
-
3.2*
35-64
12.5
22.0
1.9*
1990-
1998
5.8
*
1998-
2009
2.5*
2009-
2016
0.8
2016-
2021
-
3.9*
65+
22.3
58.6
3.2*
1990-
2005
5*
2005-
2014
3.2*
2014-
2021
-0.5
Po ugal
All
3.6
9.4
2.2*
1990-
2012
5.2
*
2012-
2021
-
1.7*
<35
0.6
1.1
1.7*
1990-
1998
5.2
*
1998-
2008
1.9*
2008-
2021
-0.4
35-64
3.4
9.1
3.1*
1990-
2003
5.2
*
2003-
2006
9.5*
2006-
2013
3.1*
2013-
2021
-
2.2*
65+
10.3
27.1
3.3*
1990-
2013
5.2
*
2013-
2021
-
2.1*
Spain
All
7.0
15.6
2.8*
1990-
1996
7*
1996-
2013
3.4*
2013-
2021
-
1.5*
<35
1.3
2.2
1.5*
1990-
1998
5.1
*
1998-
2006
1.3*
2006-
2021
-0.2
35-64
7.7
14.7
2.2*
1990-
1996
6.8
*
1996-
2011
2.9*
2011-
2021
-
1.5*
65+
16.9
44.7
3.4*
1990-
1996
6.9
*
1996-
2013
4.4*
2013-
2021
-
1.1*
*: p < 0.05; AAPC: a e age annual pe cen change; APC: a e age pe cen change; ASIR: age-s anda dized
incidence a es
