**3. Results**

Both non-melanoma and melanoma skin cancers belong to the group of cancers typical for the elderly, which can be also observed in the population of Silesia, a region in Poland (Figure 1). Incidence rates are of fundamental importance for the evaluation of a skin cancer risk due to growing effectiveness of treatment, which is related to early diagnosis, and the skin cancer's frequent recurrence.

In the Upper Silesia, continuous progression of melanoma as well as non-melanocytic skin cancers is observed. One in 60 males and one in 80 females runs a risk of developing the skin cancer till the age of 75 years. During the discussed period, i.e. 1999-2007, 4202 cases of cancer were recorded in men, and the standardized incidence rate was 14.96/100 000. The average age of the analyzed male population was 66.7 years, whereas it was 67.8 in the female population. Incidence rates increased systematically with age in both populations, and an increase in the rates was quite strong in older age groups. When compared to young males, young females developed the cancer more frequently, especially those aged 15–39 years. 4389 cases of skin cancer were recorded in women, and the standardized incidence rate was 10.94/100 000. The sex ratio was 1.37 for men due to higher incidence rates in men aged 50 years and more, and the difference increased with age (Table 1), (Figure 2).

Incidence of Melanoma and Non-Melanoma Skin Cancer in the Inhabitants of the Upper Silesia, Poland http://dx.doi.org/10.5772/55239 3

Moreover, it was the most populated area of Poland where there were 393 inhabitants per

In a retrospective epidemiological analysis, we evaluated the statistical data of the nonmelanoma skin cancer (C44 according to the 10th revision of ICD) and the cutaneous melanoma (C43) in the residents of the Upper Silesia, an administrative region established by the Local Government Reorganization Act of 1998 (effective 1 January 1999). The incidence data were obtained from the Department of Epidemiology and Silesia Cancer Registry, Maria Sklodow‐ ska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch. The nonmelanoma and melanoma incidence were estimated by calculating both, age-specific and crude rates, and the standardized incidence rates (per the population of 100 000) with the use

The cumulative risk was also calculated. The cumulative risk is the risk which an individual would have of developing the skin non-melanoma and melanoma from birth to age74 years if no other causes of death were in operation. Moreover, melanoma and non-melanoma skin cancer incidence rates were estimated according to the lesion distribution over the body. The following distribution was included into the study: the head and neck, trunk, arms and legs.

Both non-melanoma and melanoma skin cancers belong to the group of cancers typical for the elderly, which can be also observed in the population of Silesia, a region in Poland (Figure 1). Incidence rates are of fundamental importance for the evaluation of a skin cancer risk due to growing effectiveness of treatment, which is related to early diagnosis, and the skin cancer's

In the Upper Silesia, continuous progression of melanoma as well as non-melanocytic skin cancers is observed. One in 60 males and one in 80 females runs a risk of developing the skin cancer till the age of 75 years. During the discussed period, i.e. 1999-2007, 4202 cases of cancer were recorded in men, and the standardized incidence rate was 14.96/100 000. The average age of the analyzed male population was 66.7 years, whereas it was 67.8 in the female population. Incidence rates increased systematically with age in both populations, and an increase in the rates was quite strong in older age groups. When compared to young males, young females developed the cancer more frequently, especially those aged 15–39 years. 4389 cases of skin cancer were recorded in women, and the standardized incidence rate was 10.94/100 000. The sex ratio was 1.37 for men due to higher incidence rates in men aged 50 years and more, and

of a direct method and "the world's population" as a standard [9].

the difference increased with age (Table 1), (Figure 2).

1km2 .

2 Highlights in Skin Cancer

**3. Results**

frequent recurrence.

**2. Materials and methods**

**Figure 1.** Age-specific incidence rates for non-melanoma cancer (C44) and melanoma (C43) of the skin by sex, Upper Silesia, 1999–2007.


#### 4 Highlights in Skin Cancer


Cutaneous melanoma is significantly less frequent in comparison with non-melanoma skin cancers, and the same is observed in Silesia. In this area, recorded malignant melanoma incidence rates are approximately 4 times lower in men and 3 times lower in women than nonmelanoma incidence rates (Table 1, 2), (Figure 1). During the period of our studies, there were 1072 cases of cutaneous melanoma diagnosed in men, and 1282 in women. An average age of the analyzed males was 57.3 years, whereas it was 55.5 in women, thus the age was lower than in the case of non-melanoma cancer patients. The standardized incidence rates for the Silesian

Incidence of Melanoma and Non-Melanoma Skin Cancer in the Inhabitants of the Upper Silesia, Poland

for females, thus women run a slightly bigger risk of developing melanoma than men. Young adult and middle aged females are diagnosed with melanoma more frequently than males. Correspondingly to nonmelanocytic skin cancers, the cancer growth rate is bigger in men than in women, however men older than 60 years develop melanoma more frequently, and the

> **Age (years) N Rate N Rate** 0-4 0 0.00 0 0.00 5- 9 1 0.09 0 0.00 10-14 0 0.00 2 0.15 15-19 7 0.41 5 0.30 20-24 16 0.90 29 1.67 25-29 19 1.16 45 2.80 30-34 27 1.85 53 3.69 35-39 45 3.12 61 4.26 40-44 86 5.26 104 6.230 45-49 101 5.79 143 7.89 50-54 150 9.68 172 10.40 55-59 118 10.18 135 10.51 60-64 126 13.17 133 12.00 65-69 137 16.64 130 12.58 70-74 124 20.73 122 13.79 75-79 73 20.84 84 12.35 80-84 31 20.26 41 10.56 85+ 11 13.01 23 8.59 N 1072 1282 Crude rate 5.20 5.83 ASR 3.88 4.02 Cumulative 0.00% 0.00%

difference increases with aging of the population (Table 2), (Figure 1, 3).

and 4.02/105 for males and females, respectively. Sex ratio was 0.96

http://dx.doi.org/10.5772/55239

5

**Males Females**

population were 3.88/105

Median age

N – number of cases

Crude rate – cases per 100 000

ASR – age standardized rate (World Standard Population)

Cumulative – cumulative risk (0-74 years)

**Table 1.** Age-specific, crude and age-standardized incidence rates of non-melanoma skin cancer (C44) among men and women in Upper Silesia, 1999-2007.

**Figure 2.** Age-specific incidence rates for non-melanoma skin cancer in males and females, Upper Silesia, 1999–2007.

Cutaneous melanoma is significantly less frequent in comparison with non-melanoma skin cancers, and the same is observed in Silesia. In this area, recorded malignant melanoma incidence rates are approximately 4 times lower in men and 3 times lower in women than nonmelanoma incidence rates (Table 1, 2), (Figure 1). During the period of our studies, there were 1072 cases of cutaneous melanoma diagnosed in men, and 1282 in women. An average age of the analyzed males was 57.3 years, whereas it was 55.5 in women, thus the age was lower than in the case of non-melanoma cancer patients. The standardized incidence rates for the Silesian population were 3.88/105 and 4.02/105 for males and females, respectively. Sex ratio was 0.96 for females, thus women run a slightly bigger risk of developing melanoma than men. Young adult and middle aged females are diagnosed with melanoma more frequently than males. Correspondingly to nonmelanocytic skin cancers, the cancer growth rate is bigger in men than in women, however men older than 60 years develop melanoma more frequently, and the difference increases with aging of the population (Table 2), (Figure 1, 3).

**Males Females**

**Age (years) N Rate N Rate** 75-79 650 185.56 721 106.04 80-84 342 223.51 476 122.62 85+ 173 204.64 346 129.19 N 4202 4389 Crude rate 20.39 19.97 ASR 14.96 10.94 Cumulative 0.02% 0.01%

**Table 1.** Age-specific, crude and age-standardized incidence rates of non-melanoma skin cancer (C44) among men

Median age Mean age Sex ratio

Cumulative – cumulative risk (0-74 years)

and women in Upper Silesia, 1999-2007.

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

Males Females

**Figure 2.** Age-specific incidence rates for non-melanoma skin cancer in males and females, Upper Silesia, 1999–2007.

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-..

ASR – age standardized rate (World Standard Population)

N – number of cases

4 Highlights in Skin Cancer

Crude rate – cases per 100 000



statistically significant differences between males and females, namely more men developed cancers in all studied cancer sites. Such results were most evidently observed for arms (sex

Incidence of Melanoma and Non-Melanoma Skin Cancer in the Inhabitants of the Upper Silesia, Poland

**overall 4202 14.96 4383 10.94 1.37 1.31-1.43**

Head & neck (C44.0-4) 3124 11.13 3402 8.43 1.32 1.25-1.39

trunk (C44.5) 432 1.54 327 0.90 **1.71 1.47-1.99** arms (C44.6) 185 0.67 142 0.36 **1.86 1.47-2.35** legs (C43.7) 187 0.66 227 0.54 1.23 1.01-1.51

**Males Females Sex ratio N ASR N ASR 95% CI**

http://dx.doi.org/10.5772/55239

7

ratio M:F 1.86) and trunk (sex ratio M:F 1.71) (Table 3), (Figure 4, 5).

Lip & eyelid (C44.0-1) 429 1.51 562 1.48 external ear (C44.2) 376 1.34 98 0.24 face (C44.3) 2035 7.26 2517 6.15 Scalp & neck (C44.4) 284 1.01 225 0.56

**Table 3.** Site-specific rate ratios of non-melanoma skin cancer (C44) in Upper Silesia, 1999-2007.

unspecified (C44.8-9) 247 0.97 291 0.71

ASR – age standardized rate (World Standard Population)

Upper Silesia, 1999-2007.

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

**Figure 4.** Incidence rates of non-melanoma skin cancer for head and neck in males and females by 5-year age groups,

45-49

Males Head & Neck Females Head & Neck

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-..

N – number of cases

**Table 2.** Age-specific, crude and age-standardized incidence rates of cutaneous melanoma (C43) among men and women in Upper Silesia, 1999-2007.

**Figure 3.** Age-specific incidence rates for cutaneous melanoma in males and females, Upper Silesia, 1999–2007.

Cutaneous melanoma affects mainly young adults. Our collected data show that in people younger than 40 years there are 10.7% of cases of cancer in men and 15.2 % in women. Just to compare, we can say that for non-melanoma skin cancers the percentage was 2% and 2.6% for men and women, respectively, whereas the incident cases of all cancers for all those age groups are 4.1% and 5.6% for men and women, respectively. The results suggest that there are 2 epidemiology reference groups of a melanoma incidence rate for the young and old subgroups, which corresponds to the observations from other parts of Europe [10-15].

When the incidence rates for non-melanomatous skin cancers were compared in relation to the part of the patient's body affected by neoplastic lesions, it was concluded that there were statistically significant differences between males and females, namely more men developed cancers in all studied cancer sites. Such results were most evidently observed for arms (sex ratio M:F 1.86) and trunk (sex ratio M:F 1.71) (Table 3), (Figure 4, 5).


N – number of cases

**Males Females**

**Age (years) N Rate N Rate**

**Table 2.** Age-specific, crude and age-standardized incidence rates of cutaneous melanoma (C43) among men and

Mean age Sex ratio

Cumulative – cumulative risk (0-74 years)

women in Upper Silesia, 1999-2007.

0

00-04

05-09

10-14

15-19

20-24

25-29

which corresponds to the observations from other parts of Europe [10-15].

30-34

35-39

40-44

Males Females

Cutaneous melanoma affects mainly young adults. Our collected data show that in people younger than 40 years there are 10.7% of cases of cancer in men and 15.2 % in women. Just to compare, we can say that for non-melanoma skin cancers the percentage was 2% and 2.6% for men and women, respectively, whereas the incident cases of all cancers for all those age groups are 4.1% and 5.6% for men and women, respectively. The results suggest that there are 2 epidemiology reference groups of a melanoma incidence rate for the young and old subgroups,

When the incidence rates for non-melanomatous skin cancers were compared in relation to the part of the patient's body affected by neoplastic lesions, it was concluded that there were

**Figure 3.** Age-specific incidence rates for cutaneous melanoma in males and females, Upper Silesia, 1999–2007.

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-..

5

10

15

20

25

ASR – age standardized rate (World Standard Population)

N – number of cases

6 Highlights in Skin Cancer

Crude rate – cases per 100 000

ASR – age standardized rate (World Standard Population)

**Table 3.** Site-specific rate ratios of non-melanoma skin cancer (C44) in Upper Silesia, 1999-2007.

**Figure 4.** Incidence rates of non-melanoma skin cancer for head and neck in males and females by 5-year age groups, Upper Silesia, 1999-2007.

**Figure 5.** Incidence rates of non-melanoma skin cancer in males and females by 5-year age groups and anatomic site except head and neck, Upper Silesia, 1999-2007.

namely 48%, were on the trunk (C43.5). Such neoplastic lesions are equally frequent in women until they are aged 50 years, but in older patients the female incidence rates decreased, whereas the male rates increased strongly. In cancer patients aged 65-79 years, the male incidence rates for the trunk were 4 times higher than the female ones. In older men, the main cancer site is

**Males Females Sex ratio N ASR N ASR 95% CI**

http://dx.doi.org/10.5772/55239

9

**overall 1072 3.88 1282 4.02 0.96** 0.89-1.05

Incidence of Melanoma and Non-Melanoma Skin Cancer in the Inhabitants of the Upper Silesia, Poland

Head & neck (C43.0-4) 151 0.54 180 0.52 1.03 0.82-1.29

trunk (C43.5) 511 1.85 305 1.00 **1.85 1.60-2.14** arms (C43.6) 147 0.53 225 0.72 0.74 0.60-0.91 legs (C43.7) 161 0.59 494 1.55 **0.38 0.32-0.45**

Lip & eyelid (C43.0-1) 23 0.08 25 0.07 external ear (C43.2) 15 0.05 16 0.05

Scalp & neck (C43.4) 56 0.21 33 0.12

**Table 4.** Site-specific rate ratios of cutaneous melanoma (C43) in Upper Silesia, 1999-2007.

unspecified (C43.8-9) 102 0.37 78 0.23

ASR – age standardized rate (World Standard Population)

face (C43.3) 57 0.20 106 0.29

In females, in 38% of cases, the lower limbs were affected by cancer (C43.7), and a strong increase in the incidence rate was recorded for women aged 40-79 years. Such cancer site is 3 times more frequent in females than in males. We should emphasize that young females develop the skin cancer more frequently than young men, and the highest incidence rate for melanoma on legs were recorded for women aged 65-79 years. What is more, female incidence rates of melanoma for such a site are higher than male ones until old age. The incidence rate

Arms are a frequent site of melanoma both in males and females (C43.6). In the group of patients younger than 70 years, higher incidence rates are recorded for females, whereas in those older than 70 years the incidence rates are 2 times higher in men than in women. The incidence rates increased systematically with age in both populations (Table 3, 4), (Figure 6, 7).

Summing up, until 50 years of age the body parts affected by melanomas are ranked in the following order in women: legs, trunk, arms, head and neck, whereas the order is the trunk,

decreased in both population in the oldest age groups.

the trunk.

N – number of cases

The majority of the lesions was localized on the head and neck (C44.0-C44.4), i.e. 74% of all neoplastic lesions in men and 78% in women. Most of the lesions were on the face (C 44.3), i.e. 48% and 57% in men and women, respectively. The standardized incidence rate for this cancer site (head and neck) was 11.13/100 000 in men and 8.43/100 000 in women. When compared to female patients, the incidence rates of the skin cancer localized on the head and neck are growing in males aged over 50 years, and the rates are two times higher in those aged more than 75 years, whereas among younger generations more lesions were recorded in young females (Table 3), (Figure 4).

The sites of neoplastic lesions in females were ranked in the following order: trunk (C44.5), legs (C44.7) and arms (C 44.6), whereas in males they were on the trunk (C44.5), arms (C44.6) and legs (C44.7). The analysis showed that young females developed skin cancers of such localizations more frequently than males. Higher incidence rates for males than for females were recorded for the lesions on the trunk, legs and arms in patients older than 35. A strong increase was recorded for patients older than 50, and the trend persisted until old age. To sum up, it can be observed that the incidence rates related to the cancer sites are systematically increasing with age in both populations (Table 3), (Figure 5).

A specific cancer site of melanoma is sex dependent. In males, the most commonly affected body part is the trunk (especially neoplastic lesions in elderly men), whereas they are legs in females, which is also observed in the inhabitants of Silesia (Table 4), (Figure 6, 7). Among all the cases of melanoma diagnosed in male inhabitants of the Upper Silesia, most of the lesions, Incidence of Melanoma and Non-Melanoma Skin Cancer in the Inhabitants of the Upper Silesia, Poland http://dx.doi.org/10.5772/55239 9


N – number of cases

8 Highlights in Skin Cancer

00-04

females (Table 3), (Figure 4).

05-09

except head and neck, Upper Silesia, 1999-2007.

10-14

15-19

20-24

increasing with age in both populations (Table 3), (Figure 5).

25-29

30-34

35-39

40-44

45-49

trunk Males hands Males legs Males trunk Females hands Females legs Females

**Figure 5.** Incidence rates of non-melanoma skin cancer in males and females by 5-year age groups and anatomic site

The majority of the lesions was localized on the head and neck (C44.0-C44.4), i.e. 74% of all neoplastic lesions in men and 78% in women. Most of the lesions were on the face (C 44.3), i.e. 48% and 57% in men and women, respectively. The standardized incidence rate for this cancer site (head and neck) was 11.13/100 000 in men and 8.43/100 000 in women. When compared to female patients, the incidence rates of the skin cancer localized on the head and neck are growing in males aged over 50 years, and the rates are two times higher in those aged more than 75 years, whereas among younger generations more lesions were recorded in young

The sites of neoplastic lesions in females were ranked in the following order: trunk (C44.5), legs (C44.7) and arms (C 44.6), whereas in males they were on the trunk (C44.5), arms (C44.6) and legs (C44.7). The analysis showed that young females developed skin cancers of such localizations more frequently than males. Higher incidence rates for males than for females were recorded for the lesions on the trunk, legs and arms in patients older than 35. A strong increase was recorded for patients older than 50, and the trend persisted until old age. To sum up, it can be observed that the incidence rates related to the cancer sites are systematically

A specific cancer site of melanoma is sex dependent. In males, the most commonly affected body part is the trunk (especially neoplastic lesions in elderly men), whereas they are legs in females, which is also observed in the inhabitants of Silesia (Table 4), (Figure 6, 7). Among all the cases of melanoma diagnosed in male inhabitants of the Upper Silesia, most of the lesions,

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-..

ASR – age standardized rate (World Standard Population)

**Table 4.** Site-specific rate ratios of cutaneous melanoma (C43) in Upper Silesia, 1999-2007.

namely 48%, were on the trunk (C43.5). Such neoplastic lesions are equally frequent in women until they are aged 50 years, but in older patients the female incidence rates decreased, whereas the male rates increased strongly. In cancer patients aged 65-79 years, the male incidence rates for the trunk were 4 times higher than the female ones. In older men, the main cancer site is the trunk.

In females, in 38% of cases, the lower limbs were affected by cancer (C43.7), and a strong increase in the incidence rate was recorded for women aged 40-79 years. Such cancer site is 3 times more frequent in females than in males. We should emphasize that young females develop the skin cancer more frequently than young men, and the highest incidence rate for melanoma on legs were recorded for women aged 65-79 years. What is more, female incidence rates of melanoma for such a site are higher than male ones until old age. The incidence rate decreased in both population in the oldest age groups.

Arms are a frequent site of melanoma both in males and females (C43.6). In the group of patients younger than 70 years, higher incidence rates are recorded for females, whereas in those older than 70 years the incidence rates are 2 times higher in men than in women. The incidence rates increased systematically with age in both populations (Table 3, 4), (Figure 6, 7).

Summing up, until 50 years of age the body parts affected by melanomas are ranked in the following order in women: legs, trunk, arms, head and neck, whereas the order is the trunk,

over 50 years of age the rate of melanomas increases with age on legs and decreases for the trunk in women, but in men the rate increases for the trunk, however melanoma develops

Incidence of Melanoma and Non-Melanoma Skin Cancer in the Inhabitants of the Upper Silesia, Poland

http://dx.doi.org/10.5772/55239

11

When both types of skin cancers are compared, we can notice that the rates increase system‐ atically with age. The incidence rate of non-melanoma skin cancer, in comparison with melanoma, is 4 times higher in men and 2.5 times higher in women. The distribution of agespecific incidence rates indicates a strong increase in melanoma rates in patients until 40 years of age. Yet over 40 years of age, namely with aging of the population, a strong increase in the rates of non-melanoma skin cancers can be observed. In the oldest age groups of men and

The analyzed skin cancers differ in terms of the ratios of affected body parts. Huge dispro‐ portions between non-melanoma skin cancer and melanoma are recorded for the face. In men, non-melanoma skin cancers on the face comprise 48% of all skin cancers, whereas melanoma comprises 5%, while in women, it is 57% in case of non-malignant skin cancers and 8% for

Malignant neoplasms of the skin constitute the most numerous group of human malignancies, especially among representatives of a Caucasian race in the subtropical region. The two main

The skin cancer incidence rates(C44,C43) are continually increasing in the world population [10-21]. In Poland, an increasing trend has also been recorded for all age groups since the 1970s, and according to the estimations this upward trend will continue in future [19]. A systematic increase in the rates is also observed in the Silesian population [2,3,20]. In 2009, all skin cancers, including melanoma, constituted above 8% of all malignant neoplasms in male and female inhabitants of Silesia. We can compare it with the values recorded for Poland, namely 8% of cases in men and 9% in women [18]. The results presented in the tables 1 and 2 indicate that a risk of non-melanomas and melanoma in young and middle aged adults is higher for females, whereas it is higher for men in the other age groups, especially in those aged over 50 years. In the years 1999-2003, an increased incidence rate was recorded for both skin cancer types in men aged 55 years. Both skin cancer types are more frequent in young women than in men, however the skin cancer growth rate in the population of middle aged adults is higher for men, and the difference increases with age. Similar situation has been observed in all regions of

Standardized incidence rates of skin cancers were higher in the years 1999-2007 than the published values referring to the earlier periods [4-7,17]. In 1999-2003, the male standardized incidence rate of non-melanoma skin cancer was 13.50, whereas it was 9.70 for women. The incidence rate was 14.0 and 10.2 for men and women, respectively, in the years 1999-2005 [6]. During the analyzed period, i.e. 1999-2007, the value of male incidence rate increased up to

groups of the skin cancer are non-melanomas and malignant melanoma.

Poland [18,19], in Europe, and in the world population [10,16].

women, the incidence rate is approximately 12 times higher than for melanoma.

more slowly on legs.

melanoma.

**4. Discussion**

**Figure 6.** Incidence rates of cutaneous melanoma in males by 5-year age groups and anatomic site, Upper Silesia, 1999-2007.

**Figure 7.** Incidence rates of cutaneous melanoma in females by 5-year age groups and anatomic site, Upper Silesia, 1999-2007.

legs, arms, head and neck in men. At this age, the risk of developing melanomas in all parts of the body (except the torso) is higher for women than for men. On the other hand, in patients over 50 years of age the rate of melanomas increases with age on legs and decreases for the trunk in women, but in men the rate increases for the trunk, however melanoma develops more slowly on legs.

When both types of skin cancers are compared, we can notice that the rates increase system‐ atically with age. The incidence rate of non-melanoma skin cancer, in comparison with melanoma, is 4 times higher in men and 2.5 times higher in women. The distribution of agespecific incidence rates indicates a strong increase in melanoma rates in patients until 40 years of age. Yet over 40 years of age, namely with aging of the population, a strong increase in the rates of non-melanoma skin cancers can be observed. In the oldest age groups of men and women, the incidence rate is approximately 12 times higher than for melanoma.

The analyzed skin cancers differ in terms of the ratios of affected body parts. Huge dispro‐ portions between non-melanoma skin cancer and melanoma are recorded for the face. In men, non-melanoma skin cancers on the face comprise 48% of all skin cancers, whereas melanoma comprises 5%, while in women, it is 57% in case of non-malignant skin cancers and 8% for melanoma.
