Mortality trend of cutaneous melanoma in Montenegro from 1990-2018

Every year, melanoma claims over 20,000 lives in Europe. In Montenegro, as in Europe, numerous campaigns have been initiated to raise public awareness about the importance of melanoma prevention and its early detection. Thus, accompanying current diagnostic and therapeutic protocols, new methods of melanoma diagnosis and treatment have been implemented. Studying the trend enables the identification of the groups most burdened by mortality and assesses whether there has been a change in trends based on interventions aiming to reduce mortality. The objective of this study is to evaluate the mortality trend from cutaneous melanoma in Montenegro for the period 1990-2018.

We have utilized national data on the causes of death from melanoma, code 179 from the ninth and C43 from the tenth revision of the International Classification of Diseases, categorized by gender and age groups. The study utilized various regression techniques, including Joinpoint regression in the Joinpoint Program, Poisson regression, and linear regression in the SPSS 26th Program, to describe the trend.

In Montenegro, during the period from 1990 to 2018, a total of 281 individuals died (51.6% male and 48.4% female). This ranks as the 13th leading cancer in terms of mortality among all cancers. The average age-standardized rate was 1.1 deaths per 100,000 (1.2 for males and 1.0 for females).  The number of death cases has been increasing on average by 3.3% annually [average annual percentage change (AAPC) (95% CI) = 3.3 (1.7-4.9); p<0.001] on an overall level and by 5.4% annually among males [AAPC (95% CI) = 5.4 (3.6-7.3); p<0.001] due to the rises in the age groups 55-64 years and 65-74 years with an average annual percent change of respectively 3.2% [AAPC (95% CI) = 3.2 (0.8-5.8); p=0.012] and 5.4% [AAPC (95% CI) = 5.4 (2.7-8.1); p<0.001] overall level, and 4.8% [AAPC (95% CI) = 4.8 (2.4-7.3); p<0.001] and 7.5% [AAPC (95% CI) = 7.5 (4.9-10.2); p<0.001] among males. For females, an increase of 1.1% was recorded, which was not statistically significant [AAPC (95% CI) = 1.1 (-0.8-3.0); p=0.255]. Furthermore, there was a noted increase in the rates at an overall level [β (95% CI) = 0.027 (0.008-0.046); p=0.007] and in the age group 65-74 years [β (95% CI) = 0.249 (0.090-0.407); p=0.003], as well as among males at an overall level [β (95% CI) = 0.052 (0.025-0.079); p<0.001] and for age groups 45-54 years [β (95% CI) = 0.102 (0.011-0.193); p=0.030] and 65-74 [β (95% CI) = 0.410 (0.144-0.676); p=0.004]. In contrast, the rates for females remained constant. The three age groups most burdened by melanoma skin cancer mortality are 65-74 years (23.5%), 55-64 years (21.7%) and 75-84 years  (19.2%).

The results of regression analyses indicate a significant rise in both the number of death cases and mortality rates overall, specifically among males in Montenegro. In females, however, the increase in the number of death cases and rates is not statistically significant. Preventive campaign activities should be redirected towards the most vulnerable groups in terms of mortality, namely males and the elderly population.