Long-term changes in melanoma epidemiology in Hungary: who are the high-risk groups, and where should we concentrate prevention programs?

Numerous studies have concentrated on the epidemiology of melanoma in Hungary in recent years. The incidence rates often conflict in these studies; however, the prognosis has unambiguously improved. Our objective was to investigate melanoma epidemiology from a spatial perspective by relying on healthcare databases to identify high-risk groups and reveal geographical differences over a 20-year study period. We calculated age-standardised incidence rates in each Nomenclature of Territorial Statistical Level 3 (NUTS-3) region (county) for 2001–2019 for the 45–64 and 65 years or older populations, stratified by sex. We applied the European Revised Reference Population (2012) for standardisation. Furthermore, we used the Joinpoint Trend Analysis software to calculate the annual percent change (APC) to determine whether the incidence trends were statistically significant. We then analysed 10-year-specific APCs in the population above 45 years of age. Additionally, we performed the Joinpoint Trend Analysis on the age-adjusted death rates in the population between 45 and 64 years and 65 years or older at the NUTS-2 level. Melanoma showed a 1.8% and 1.5% increase in melanoma incidence in individuals aged 45–64 years. ASIRs increased in men from 2010 to 2015 by 8.2% and in women without breakpoints by 4.1% between 2001 and 2019. We also demonstrated geographical differences in the incidence trends. We observed increasing trends in incidence rates in men in counties with low socioeconomic status, such as northern counties, and women in Southern Transdanubia. Our findings warrant further research on the relationship between melanoma incidence and socioeconomic status. Decreasing incidence trends from 45 to 64 years of age were observed in Vas and Hajdú-Bihar counties. Our most noteworthy finding pertains to the vulnerability of 45–54 year old women and highlights the urgency of efficient prevention and screening campaigns. Melanoma mortality in most regions stagnated or decreased, except for Western Transdanubia among the population above 65 years of age. Our study results could aid policymakers in designing awareness and screening campaigns in areas with a dynamically increasing incidence of melanoma. Particular attention should be given to areas with low socioeconomic status.