Department of Plastic Surgery, City General Hospital, North Staffordshire Hospitals NHS Trust, Stoke-on-Trent, UK
Introduction North Staffordshire describes an area in Staffordshire, in the West Midlands region of England. The incidence of melanoma is increasing in North Staffordshire. A retrospective audit was performed to identify patients with ‘thin’ melanomas (≤1 mm), and compare their characteristics with all melanoma patients diagnosed from the same period.
Methods Patients diagnosed within the University Hospital of North Staffordshire NHS Trust with melanoma, between 1999 and 2009, were identified. Exclusion criteria were: (1) In situ disease or non-melanoma disease; (2) Primary diagnosis outside of date range; (3) Metastatic disease at presentation; (4) No primary skin lesion identified or histopathology specimen/report unavailable; (5) No medical records available; (6) Non-NHS patients or NHS patients diagnosed outside of the North Staffordshire region.
Results 507 patients with melanoma were identified, with 49% classified as ‘thin’. The majority of these were of the superficial spreading subtype (72.4%). The incidence in this group increased by 181%, compared to an overall increase of 111% (all melanomas) over the study period. Age at diagnosis was significantly less in the ‘thin’ group compared to all melanomas (P<0.001). The anatomical distribution was similar in both groups. More females were affected by ‘thin’ melanomas (65%) compared to the group as a whole (55%), although 57% of deaths occurred in males. 5-year survival in this group was 92%.
Conclusion In summary, the present study provides a unique picture of the contemporary management of malignant melanoma in a Central England population. The population appears to be representative of the UK as a whole, with a better than expected survival rate in ‘thicker’ melanomas. This study focused on the apparent increasing incidence of thin melanomas, and the associated significant mortality. Whilst melanoma has more than doubled in incidence over the last 10 years in North Staffordshire, the incidence of thin melanoma has nearly tripled. This may be due to enhanced surveillance and increased patient education in the region, leading to earlier diagnosis.