ORIGINAL ARTICLE Renee A. Harrison1, Seng-jaw Soong1, John ...€¦ · Renee A. Harrison1, Seng-jaw...

JOURNAL OF INSURANCE MEDICINECopyright © 1998 By Journal of Insurance Medicine

ORIGINAL ARTICLE

Comparative Mortality of Patients Diagnosed with Localized and In Situ MelanomasRenee A. Harrison1, Seng-jaw Soong1, John A. H. Lee2

Abstract: Background: The rates for incidence and mortality fl’ommelanoma are continuing to rise, although long term survival experi-ence for patients with in situ and localized melanomas is favorable.

Results: Excess mortality varied with age at diagnosis, sex, durationsince diagnosis and tumor thickness.

Conclusions: Compared to the general white population in the UnitedStates, patients with localized melanoma experience a mild increase inExcess Death Rates (EDRs) the first year following diagnosis. For 1-5years following diagnosis the EDRs are markedly increased across allage groups and decline thereafter. At 15-20 years following diagnosisthe EDRS are not elevated except among patients < 40 years of age atdiagnosis. Patients with tumors > 1.5 mm thick have mild to moderateincreases in EDR for the first year following diagnosis, and extremelyhigh EDRs up to 5 years. There is no elevation in mortality ratios orEDR for patients diagnosed with in situ melanomas.

Address:Renee A. Harrison, Ph.D., Biostatis-tics Unit Comprehensive CancerCenter, University Of Alabama atBirmingham, 1824 Sixth AvenueSouth, #153, Birmingham, AL 35294-3300

Correspondence:Renee A. Harrison, Ph.D.

Key Words: Melanoma, Follow-upStudy, SEER, Mortality, Risk Factors.

Received: 9/11/98

Accepted: 11/20/98

Journal of Insurance Medicine1998;30:157-168

Objective of This AbstractTo develop comparative mortality results ofpatients diagnosed with localized melanomafrom the SEER (Surveillance, Epidemiology,and End Results) Registry~ and from the com-bined University of Alabama at Birmingham/University of Sydney, Australia(UAB/AUS)2 hospital registry. A brief dis-cussion of comparative mortality of in situmelanomas is also presented.

BackgroundThe rates for incidence and mortality frommalignant melanoma are continuing to rise,although the trends are beginning to slow.There is no evidence as time has passed thatpatients with tumors diagnosed at a givenstage with comparable tumor thickness aresurviving any better. What has occurred isthat many melanomas are being diagnosed atan earlier stage.

Localized melanoma can have a variedcourse and mathematical models have identi-

fied tumor thickness as the most importantprognostic factor for survival. The currentstaging system for melanoma is based on theAJCC (American Joint Commission on Can-cer)3 system. Localized disease without nodalinvolvement is classified as stages I and IIand. pathologic staging of the primarymelanoma is based on microscopic assess-ment of the depth of invasion and thicknessof the primary tumor. Generally, tumors of <1.5mm thick are Stage I and lesions of > 1.5mm thick are stage II. Pathologic staging alsotakes into account level of invasion and incases of discrepancy between tumor thick-ness and level, the pathologic stage is basedon the less favorable finding. Regional lymphnode involvement and/or in transit metas-tases are classified as stage III. Systemicmetastases are stage IV.

1 Biostatistics Unit, Comprehensive Cancer Center, University ofAlabama at Birmingham, Birmingham, AL.

2 Department of Public Health Sciences, Fred Hutchinson CancerCenter, University of Washington, Seattle, WA.

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JOURNAL OF INSURANCE MEDICINE VOLUME 30 NUMBER 3 1998

Subjects StudiedSEERThe SEER program of the US National CancerInstitute (I~CI) is a population based system ofcancer registration and follow-up covering thepopulations of nine geographic regions of theUS. The SEER areas include the states of Con-necticut, Hawaii, Iowa, New Mexico andUtah; and the metropolitan areas of Atlanta,Detroit, San Francisco/Oakland and Seat-tle/Puget Sound. These areas include about14 % of the US population designed to be rep-resentative of the US cancer experience.

Of 35,217 patients diagnosed with localizedmelanoma between January 1, 1973 andDecember 31, 1993 slightly over half (50.8%)were male. The median age at diagnosis is54.4 years for males and 50.9 years for females.Of 10,284 in situ lesions reported during thesame time period, 53.8% were diagnosed inmales. Specific tumor characteristics such astumor thickness are not recorded in the SEERdatabase. For purposes of this analysis,patients with no survival data were excluded(n=881 localized cases and n=501 in situcases).

UAB/AustraliaData were collected prospectively since 1969at the University of Sydney Melanoma Unitand since 1975 at the University of Alabama.Additional data on melanoma patients treatedat these centers were collected retrospectivelyto 1950. Of 4568 patients in the database 50%had primary lesions on their arms or legs. Thenumber of male patients was slightly greaterthan the number of female patients. Tumorthickness was _<l.5mm in 61.8% of the patients.The median age at diagnosis was 45.4 years formales and 43.2 years for females with tumors_< 1.Smm. For tumors > 1.Smm, the medianage at diagnosis was 52 years for males andfemales.

Follow-upSEERContractors maintaining a cancer informationreporting system with SEER provide follow-

up on all living patients except those with insitu cancer of the cervix. Computer tapes aresubmitted twice yearly to NCI. Follow-up ofpatients diagnosed from 1973-1993 is completeto December 31, 1993.

UAB/AUSThe most recent follow-up of patients was in1996 for Australia patients; the median follow-up time is 7.8 years and the maximum is 43years. Over 95% of the patients have some fol-low-up.

Expected MortalityThe actual age and sex distribution for boththe SEER population and UAB/AUS popula-tion was available for computation of expect-ed deaths based on single years of age. Thecomparative population used for determina-tion of expected deaths was the U.S. Whitepopulation. Recent Australia mortality ratesare close enough to those in the U.S. popula-tion to make unnecessary any adjustment inthe Australia portion of the experience.Melanoma patients with comorbidity were notexcluded.

ResultsSEER LocalizedTables I and 2 show the comparative mortali-ty experience for the SEER population for allages combined for males and females, respec-tively. For both sexes the mortality ratios arehigher for 1-5 years following diagnosis com-pared to the first year. Males have an EDR of26.3/1000 for years 1-5 compared to 16.5/1000for females. By 5-10 years the EDRs are mild-ly increased in both sexes and slight increasespersist up to 15 years. After 15 years followingdiagnosis no excess deaths are observed foreither sex.

Data from Tables 3 and 4 display the mortalityexperience for males and females by durationsince diagnosis for age groups in decades.Individuals aged 15-29 comprise only about10% of the melanoma cases, but nearly.1.76female cases are diagnosed for every 1 malecase. Females in this age group have a higher

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VOLUME 30 NUMBER 3 1998 JOURNAL OF INSURANCE MEDICINE

mortality ratio than males in every time peri-od following diagnosis. For males, the mor-tality ratio is highest in years 1- 5 since diag-nosis (MR-- 1400%). Both males and femaleshave a greater EDR in years 1-5 followingdiagnosis compared to the first year. For years1-5, males have nearly twice as high EDR val-ues as females.

Among patients aged 30-39 years at diagnosis,the proportion of female cases is 57.7%. TheEDR is the highest during years 1-5 followingdiagnosis for males and females. Althoughthere are still 8.4 excess deaths/1000 infemales at 15-20 years of follow-up, there areno excess deaths in males at this time periodbased, however, on only 2 deaths.

A nearly equal proportion of males andfemales are diagnosed at age 40-49 years. Theexcess death rates for males are higher thanfemales for the first 5 years. Males experience25.4 extra deaths/1000 for years 1-5 comparedto 14.1/1000 for females. After 10 years theEDR drops to < 10/1000 in males and females.

The greatest proportion of total melanomacases is diagnosed among individuals aged50-59 years. In this age group the number ofmale cases exceeds that of females. The EDRis higher for males than females up to 10 yearsfollowing diagnosis. For follow-up 1 to 5years, the EDR for males is 24.4/1000, and17.4/1000 for females.

Patients aged 60-69 have slightly higher EDRscompared to patients aged 50-59 although themortality ratios continue to decline. The EDRsfor males and females are 25.3/1000 and18.0/1000, respectively for years 1-5. Thereare no excess deaths after year 15, although thenumbers of deaths and number of exposure -years are small.

Older patients age 70-79 years continue tohave a higher excess death rate compared toyounger age groups, although the pattern ofhigher EDRs among males compared tofemales is less evident. The highest EDR is at

1-5 years following diagnosis for males,28.9/1000, and females, 31.5/1000. In females,the EDRs do not decline much 5 to 15 years offollow-up.

The oldest patients aged 80 and over at diag-nosis have the highest EDRs at 1-5 years com-pared to the younger age groups. The EDR at1-5 years is 50.2 in males compared to 32.7 infemales. No substantial follow-up is availablefor any patients beyond 15 years.

Tables 5 and 6 show the comparative mortali-ty for patients diagnosed with in situ lesionsfor all ages combined, by sex, and years of fol-low-up. Patients diagnosed with in situmelanoma experience mortality rates less thanor about equal to those of the U.S. population.The mortality ratios are generally <100 andEDRs are negative for both male and femalepatients.

UAB/AUSAmong a cohort of UAB/AUS patients withmelanomas <l.5mm thick there are no excessdeaths among males or females during thefirst year of follow-up (Tables 7 and 8). TheEDRs increase at 2-3 years following diagnosisand then decline. The EDRs for males slightlyexceed those for females. After 10 years of fol-low-up there are no significant excess deathsin males and only a few in females.

For UAB/AUS patients with tumors > 1.5mmthickness, the EDRs are much greater than forthose with thinner tumors (Tables 9 and 10).For duration years 1-5 the EDR is 74.4 in malesand 52.5 in females. For duration years 7-10years the EDRs are still elevated in males(25.7) and females (15.6).

CommentCompared with the general white populationin the United States, SEER patients with local-ized melanoma experience mild EDRs thefirst year following diagnosis. For duration 1-5 years following diagnosis the EDRs aremarkedly increased across all age groups anddecline thereafter. Males in general experi-

159


ence higher EDRs than females of the sameage with the exception of elderly women(aged 70 and over) who have survived 10years beyond diagnosis compared to men.

Among data derived from the experience oftwo tertiary care centers, patients with tumors> 1.5 mm thick have moderately increasedEDRs for years 0-1, and much higher EDRs upto 5 years. Patients with thin lesions (<1.5mm) have a more favorable mortality experi-ence compared to patients with thickertumors.

This comparative mortality analyses can beused as a basis for calculation for quantifica-tion of excess mortality. These UAB/AUSdata replace and supplement tables presentedin Abstract 5482 Although tumor thickness isrelated to EDR, pathologic information maynot be available to insurers, and risk analysiscan be computed based on sex, age of diagno-sis, and years since diagnosis. Currently thereare no new nonsurgical therapies withimproved results that have been introducedwhich need to be factored into the calcula-tions.

There is no elevation in mortality ratios orEDRs for patients diagnosed with in situlesions from the SEER registry. Melanoma insitu is a lesion of uncertain natural history?With surgical management, melanoma in situshould have no impact on a patient’s longevi-ty or insurability as shown in this analysis ofpatients not subject to insurance selection.The proportion of cases reported as in situ tothe SEER registry (confined to the epidermis)has greatly increased, especially among olderpatients.

The shift in diagnosis to thinner lesions hasalso occurred for localized cases. This couldhave some impact on the survival figuresreported over the 21 year period, but inclusionof localized melanoma cases reported to theSEER from the earliest years 1973-1976 (18.8%of all cases) would make the EDRs in thisreport more conservative. Any improved sur-vival is likely to be due to a favorable shift inthe depth distribution of tumors at diagnosis,a factor not recorded in the SEER registry.

The combined UAB/AUS patient populationin this analysis represents a hospital referralpopulation that will certainly differ from themelanoma patients in the general population.In the current study, 21% of the patients in thisstudy had ulcerated lesions compared to 9%from the American College of Surgeon’s (ACS)population survey in 1981. Ulceration andtumor thickness are known prognostic factorsfor survival from localized melanoma.

APPENDIXDefinitions of abbreviations used in the textand Tables

E:d:d’:q:

MR:

living at start of intervalexposure in patient yearsdeaths, observeddeaths, expectedmean annual mortality rate, observedper 1000mean annual mortality rate, expectedper 1000excess death rate (EDR)mortality rate as 100 d/d’

ACKNOWLEDGEMENTSThe authors thank Dr. Richard Singer for histhoughtful critique of this analysis, and hisenthusiasm for the discipline of insurancemedicine.

References1. Surveillance, Epidemiology and End Results (SEER) Program

public use CD-ROM (1973-1993), National Cancer Institute,DCPC, Surveillance Program Cancer Statistics Branch, releasedFebruary 1997, based on the February 1996 submission.

2. Balch CM, Soong S-j, Shaw HM Milton GW. "An Analysis ofPrognostic Factors in 8600 Patients with Cutaneous Melanoma."In Cutaneous Melanoma, Balch CM and Milton GW, eds. 2rided, 1992. Philadelphia: Lippincott.

3. Manual for Staging of Cancer, 4th edition. American Joint Com-mittee on Cancer. 1992. Philadelphia: Lippincott.

4. Melanoma In Situ Series. Human Pathology 1998;29:1-14.5. Lew EA, Gajewski J, eds. Medical Risks: Trends in Mortality by

Age and Time Elapsed. Volume 1. 1990 Westport, Conn.,Praeger. See Chapter 5, Abstract 548, "Melanoma- Alabama andSydney, Australia."

160


Table 1.

Comparative Mortality (MR and EDR) for White Men with Localized Melanoma by Duration,SEER Experience 1973-1993. Median age at diagnosis 52 years.

Interval No. aliveStart-End at start

Exposure No. of Deaths MortalityMean Annual Morality Rate/1000Pt.-Years Observed Expected* Ratio Observed Expected Excess

t to At d E d d’ 100 d/d’ q q’ q-q’

0-1 17,499 16,790.5 482 416.4 116 28.7 24.8 3.91 - 2 15,600 14,935.0 771 379.3 200 51.6 25.4 26.22- 3 13,499 12,886.5 716 328.6 220 55.6 25.5 30.13- 4 11,558 11,006.5 584 282.9 210 53.1 25.7 27.44- 5 9781 9400.0 433 246.2 176 46.1 26.3 19.81 - 5 15,600 48,228.0 2504 1237 200 51.9 25.6 26.3

5- 6 8496 8082.0 323 216.6 149 40.0 26.8 13.26- 7 7345 6940.0 260 190.9 136 37.5 27.5 10.07- 8 6275 5897.5 224 165.7 135 38.0 28.1 9.98- 9 5296 4949.5 167 141.6 118 33.7 28.6 5.19-10 4436 4163.0 127 121.1 105 30.5 29.1 1.45-10 8496 30,032.0 1101 835.9 132 36.7 27.8 8.9

10-11 3763 3507.5 121 104.9 115 34.5 29.9 4.611- 12 3131 2907.5 102 89.0 115 35.1 30.6 4.512-13 2582 2386.0 85 75.4 113 35.6 31.6 4.013-14 2105 1917.5 61 62.1 98 31.8 32.4 #14-15 1669 1509.0 56 51.6 109 37.1 34.2 2.910-15 3763 12,227.5 425 383.0 111 34.8 31.3 3.5

15- 20 1293 3142.5 94 109.6 86 29.9 34.9 #

*Basis of expected deaths: matching contemporary U.S. Life tables, 1973-1993.# Observed rate less than expected.

161


Table 2.

Comparative Mortality (MR and EDR) for White Women with Localized Melanoma byDuration, SEER Experience 1973-1993. Median age at diagnosis 52 years.

Interval No. alive

Start-End at start

Exposure No. of Deaths MortalityMean Annual Morality Rate/1000Pt.-Years Observed Expected* Ratio Observed Expected Excess

t to At g E d d’ 100 d/d’ q q’ q-q’

0-11-22-33-44-51-5

16,83715.28913,66212.01910.61915.289

16,189.0 252 216.9 116 15.6 13.4 2.214,685.5 420 201.2 210 28.6 13.7 14.913,069.5 457 183.0 250 35.0 14.0 21.011,497.0 356 161.0 220 31.0 14.0 17.010,153.0 276 147.2 188 27.2 14.5 12.749,405.0 1509 692.4 220 30.5 14.0 16.5

5-6 9411 8951.0 230 132.5 174 25.7 14.8 10.96-7 8261 7812.5 184 118.8 155 23.6 15.2 8.47-8 7180 6776.0 155 107.1 145 22.9 15.8 7.18-9 6217 5840.5 125 95.2 131 21.4 16.3 5.1

9-10 5339 5014.5 107 83.7 128 21.3 16.7 4.65-10 9411 34,394.5 801 537.3 149 23.3 15.6 7.7

10-11 4583 4290.5 90 73.8 122 21.1 17.2 3.911-12 3908 3635.0 82 62.9 130 22.6 17.3 5.312-13 3280 3010.0 71 54.5 130 23.6 18.1 5.513-14 2669 2419.0 57 45.5 125 23.6 18.8 4.814-15 2112 1881.5 50 37.8 132 26.6 20.1 6.510-15 4583 15,236.0 350 274.5 128 22.9 18.0 4.9

15-20 1601 3880.0 86 87.7 98 22.2 22.6 #


162


Table 3.

Comparative Mortality (MR and EDR) for White Men with Localized Melanomaby Age and Duration, SEER Experience, 1973-1993

Interval No. aliveStart-End at start

t to At g

0- 1 11881-5 10955-10 693

10-15 39015-20 176

0-1 25151-5 23125-10 1412

10-15 67715-20 238

0-1 31281-5 28095-10 1607

10-15 78815-20 307

0-1 35241-5 31955-10 1950

10-15 97115-20 365

0-1 36911-5 32875-10 1758

10-15 66215-20 161

0-1 24991-5 21485-10 887

10-15 24915-20 42

0-1 9541-5 7545-10 189

10-17 26

Exposure No. of Deaths Mo~a~ty Mean Annual Morality Rate/1000Pt.-Years Observed Expected* Ratio Observed Expected Excess

E d d’ 100 d/d’ q q’ q-q’

Age 15-29Years1145.0 7 2.1 330 6.1 1.8 4.33626.0 88 6.3 1400 24.3 1.8 22.52647.0 33 4.7 700 12.5 1.8 10.71427.5 17 3.1 550 11.9 2.2 9.7441.5 7 1.4 500 15.9 3.2 12.7

Age 30-39Years2423.0 19 4.6 410 7.8 1.9 5.97437.0 202 16.5 1220 27.2 2.2 25.05103.5 74 16.0 460 14.5 3.1 11.42228.0 25 11.2 220 11.2 5.0 6.2553.0 2 4.3 47 3.6 7.8 #

Age 40-49 Years2986.0 35 12.8 270 11.7 4.3 7.48759.0 270 47.2 570 30.8 5.4 25.45858.5 116 47.6 245 19.8 8.1 11.72656.5 54 35.3 153 20.3 13.3 7.0807.0 16 16.0 100 19.8 19.8 0.0

Age 50-59Years3389.0 59 38.3 154 17.4 11.3 6.1

10380.0 399 145.6 275 38.4 14.0 24.46246.0 221 149.4 148 35.4 23.9 11.53239.0 94 100.0 94 29.0 30.9 #883.0 30 38.3 78 34.0 43.4 #

Age 60-69Years3546.0 114 94.7 120 32.1 26.7 5.4

10137.0 583 326.2 179 57.5 32.2 25.35999.5 301 270.7 111 50.2 45.1 5.11918.5 134 123.6 108 69.8 64.4 5.4381.5 23 35.6 65 60.3 93.3 #

Age 70-79Years2384.5 122 138.8 88 51.2 58.2 #6041.5 588 413.1 142 97.3 68.4 28.92698.5 257 251.8 102 95.2 93.3 1.9688.0 85 92.1 92 12.3 13.4 #72.5 14 12.7 110 19.3 17.5 1.8

Age 80YearsUp+917.0 126 124.5 101 137.4 135.8 1.6

1847.5 374 281.2 133 202.4 152.2 50.2479.0 99 89.5 111 206.7 186.8 19.9

73.0 18 18.3 98 246.6 250.7 #*Basis of expected deaths: matching contemporary U.S. Life tables, 1973-1993.# Observed rate less than expected. + Median age at diagnosis was 84.7 years.

163


Table 4.

Comparative Mortality (MR and EDR) for White Women with Localized Melanoma by Age andDuration, SEER Experience, 1973-1993

Interval No. alive Exposure No. of Deaths Mortality Mean AnnualMorality Rate/1000Start-End at start Pt.-Years Observed Expected* Ratio Observed Expected Excess

t to At g E d d’ 100 d/d’ q q’ q-q’Age 15-29 Years

0-1 2088 2004.0 8 1.2 670 4.0 0.6 3.41-5 1912 6348.0 64 3.9 1640 10.1 0.6 9.5

5-10 1274 4804.5 32 3.7 865 6.7 0.8 5.910-15 687 2397.5 19 2.5 760 7.9 1.0 6.815-20 261 662.0 6 1.1 545 9.1 1.7 7.4

Age 30-39 Years0-1 3430 3286.0 7 2.9 240 2.1 0.9 1.21-5 3135 7795.5 120 11.7 1030 15.4 1.5 13.9

5-10 2028 7424.5 59 12.6 470 7.9 1.7 6.210-15 998 3226.0 23 8.7 265 7.1 2.7 4.415-20 325 724.5 9 2.9 310 12.4 4.0 8.4

Age 40-49 Years0-1 3132 2995.0 10 6.9 145 3.3 2.3 1.01-5 2848 9126.5 154 25.8 600 16.9 2.8 14.1

5-10 1761 6448.0 102 27.7 370 15.8 4.3 11.510-15 897 3064.5 39 19.8 200 12.7 6.5 6.215-20 341 896.0 7 9.3 75 7.8 10.4 #

Age 50-59 Years0-1 2863 2776.0 20 15.8 126 7.2 5.7 1.51-5 2669 9020.5 220 62.9 350 24.4 7.0 17.4

5-10 1808 7025.5 121 71.8 169 17.2 10.2 7.010-15 998 3413.0 61 51.8 118 17.9 15.2 2.715-20 385 945.0 20 20.8 96 21.2 22.0 #

Age 60-69 Years0-1 2472 2400.5 46 31.7 145 19.2 13.2 6.01-5 2283 7423.0 253 119.3 210 34.1 16.1 18.0

5-10 1416 4147.0 160 121.4 132 38.6 29.2 9.410-15 668 2211.0 84 83 101 38.0 37.5 0.515-20 222 519.5 30 31.9 94 57.7 61.4 #

Age 70-79 Years0-1 1801 1724.0 68 55.0 124 39.4 31.9 7.51-5 1579 4807.0 343 191.7 179 71.4 39.9 31.5

5-10 816 2647.5 193 161.6 119 72.9 61.0 11.910-15 260 719.0 83 68.1 122 115.4 94.7 20.715-20 51 104.5 7 14.4 49 67.0 137.8 #

Age 80 Years Up+

0-1 1051 1003.5 93 102.6 91 92.7 102.2 #1-5 863 2384.0 355 277.1 128 148.9 116.2 32.7

5-10 308 897.5 134 137.9 97 149.3 153.6 #10-19 75 233.5 48 49.0 98 205.6 209.9 #

*Basis of expected deaths: matching contemporary U.S. Life tables, 1973-1993.# Observed rate less than expected.+ Median age at diagnosis was 85.1 years.

164


Table 5.

Comparative Mortality (MR and EDR) for White Men with In Situ Melanoma by Duration, SEERExperience 1973-1993. Median age at diagnosis 61.8 years.


t to At ~ E d d’ 100 d/d" q q’ q-q’

0-1 5284 4950.5 109 186.1 59 22.0 37.6 #1-2 4508 4195.0 127 165.3 77 30.3 39.4 #2-3 3755 3481.5 102 141.3 72 29.3 40.6 #3-4 3106 2868.0 112 126.0 89 39.1 42.2 #4-5 2518 2315.0 87 95.4 91 37.6 41.2 #0-5 5284 1~810.0 537 714.1 75 30.2 40.0 #

5-6 2025 1862.5 64 84.4 76 34.4 45.3 #6-7 1636 1489.5 48 70.0 69 32.2 47.0 #7-8 1295 1176.5 50 57.8 87 42.5 49.1 #8-9 1008 908.0 37 43.6 85 40.7 48.0 #

9-10 771 704.5 28 35.0 80 39.7 49.7 #5-10 2025 6141.0 227 290.8 78 37.0 47.3 #

10-11 610 552.0 28 27.9 100 50.7 50.6 011-12 466 415.0 15 20.4 74 36.1 49.1 #12-13 349 314.0 18 15.5 116 57.3 49.4 813-14 261 228.5 8 11.1 72 35.0 48.4 #14-15 188 172.5 8 8.3 96 46.4 48.0 #10-15 610 1682.0 77 83.2 93 45.8 49.5 #

15-20 149 281.0 10 14.6 68 35.6 51.9 #


165


Table 6.

Comparative Mortality (MR and EDR) for White Women with In Situ Melanoma by Duration,SEER Experience 1973-1993. Median age at diagnosis 56.5 years.

Interval No. alive Exposure No. of DeathsStart-End at start Pt.-Years Observed Expected*

Mortality Mean AnnualMorality Rate/1000Ratio Observed Expected Excess

t to At ~ E d d’ 100 d/d’ q q’ q-q’

0-1 4499 4213.5 48 81.3 59 11.4 19.3 #1-2 3880 3615.5 54 73.8 73 14.9 20.4 #

2-3 3297 3071.5 71 65.4 109 23.1 21.3 23-4 2775 2563.0 42 58.2 72 16.4 22.7 #4-5 2309 2140.0 50 51.8 97 23.4 24.2 #0-5 4499 15,063.5 265 330.5 80 17.6 21.9 #

5-6 1921 1778.5 41 44.8 92 23.1 25.2 #6-7 1595 1463.5 32 38.2 84 21.9 26.1 #7-8 1300 1190.5 32 32.6 98 26.9 27.4 #8-9 1049 949.5 31 27.3 114 32.6 28.8 #

9-10 819 739.5 16 21.8 73 21.6 29.5 #5-10 1921 6121.5 152 164.7 92 24.8 26.9 #

10-11 644 584.5 13 18.1 72 22.2 31.0 #11-12 512 456.5 14 14.6 96 30.7 31.9 #12-13 387 347.5 10 11.0 91 28.8 31.8 #13-14 298 261.5 6 8.3 72 22.9 31.7 #14-15 219 197.5 7 6.5 108 35.4 33.0 210-15 644 1847.5 50 58.5 85 27.1 31.7 #

15-20 169 365.0 7 12.2 57 19.2 33.4 #


166


Table 7.

Comparative Mortality (MR and EDR) for White Men with Localized Melanoma by Duration,UAB/AUS, 1950-1996, Tumor Thickness < 1.5mm, Median age at diagnosis 45.4 years.


Mortality Mean AnnualMorality Rate / 1000Ratio Observed Expected Excess


0-1 1209 1151.0 0 10.4 0 0.0 9.0 #1-2 1093 1064.5 19 9.7 196 17.8 9.1 8.72-3 1017 991.0 30 9.6 310 30.3 9.7 20.63-4 935 908.0 21 9.6 220 23.1 10.6 12.54-5 860 825.5 20 9.0 220 24.2 10.9 13.31-5 3905 3789.0 90 37.9 240 23.8 10.0 13.8

5-7 1460 1388.0 31 16.8 185 22.3 12.1 10.27-10 1512 1404.5 24 19.7 122 17.1 14.0 3.1

10-15 1343 1246.5 13 20.2 64 10.4 16.2 #15-20 516 467.0 8 9.4 85 17.1 20.1 #

* Basis of expected deaths: U. S. Decennial Life Tables 1989-91.# Observed rate less than expected.

Table 8.

Comparative Mortality (MR and EDR) for White Women with Localized Melanoma by Duration,UAB/AUS, 1950-1996, Tumor Thickness < 1.5mm, Median age at diagnosis 43.2 years.


tto At ~ E d d’ 100 d/d’ q q’ q-q’

0-1 1616 1554.0 1 6.5 15 0.6 4.2 #1-2 1491 1455.5 9 6.5 138 6.2 4.5 1.72-3 1411 1374.5 22 6.6 330 16.0 4.8 11.23-4 1316 1282.5 19 6.6 290 14.8 5.1 9.74-5 1230 1198.5 18 6.4 280 15.0 5.3 9.71-5 5448 5311.0 68 26.1 260 12.8 4.9 7.9

5-7 2197 2096.5 27 13.0 210 12.9 6.2 6.77-10 2400 2245.5 19 16.5 115 8.5 7.3 1.2

I0-15 2166 2010.0 26 18.4 141 12.9 9.2 3.715-20 947 873.0 7 11.0 64 8.0 12.6 #

* Basis of expected deaths: U. S. Decennial Life Tables 1989-91.# Observed rate less than expected.

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Table 9.

Comparative Mortality (MR and EDR) for White Men with Localized Melanoma by Duration,UAB/AUS, 1950-1996, Tumor Thickness > 1.5mm, Median age at diagnosis 52.0 years.


Mortality Mean AnnualMorality Rate/1000Ratio Observed Expected Excess

t to At d E d d’ 100 d/d’ q q’ q-q’0-1 981 970.5 34 15.3 220 35.1 15.8 19.31-2 925 910.5 92 15.2 605 101.0 16.7 84.32-3 804 792.5 70 13.5 519 88.3 17.0 71.33-4 711 693.5 64 12.5 510 92.3 18.0 74.34-5 612 597.0 49 11.3 435 82.1 18.9 63.21-5 3052 2993.5 275 52.5 525 91.9 17.5 74.4

5-7 992 946.0 46 18.7 250 48.6 19.8 28.87-10 976 917.0 43 19.4 220 46.9 21.2 25.7

10-15 859 801.0 20 18.7 107 25.0 23.3 1.715-20 354 328.0 6 8.0 75 18.3 24.4 #

*Basis of expected deaths: U. S. Decennial Life Tables 1989-91.# Observed rate less than expected.

Table 10.

Comparative Mortality (MR and EDR) for White Women with Localized Melanoma by Duration,UAB/AUS, 1950-1996, Tumor Thickness > 1.5mm, Median age at diagnosis 52.0 years.



0-1 762 749.0 10 6.8 147 13.4 9.1 4.31-2 726 719.0 47 6.8 690 65.4 9.5 55.92-3 665 654.0 38 6.4 595 58.1 9.8 48.33-4 605 588.5 35 6.0 580 59.5 10.2 49.34-5 537 523.0 35 5.3 660 66.9 10.1 56.81-5 2533 2484.5 155 24.5 630 62.4 9.9 52.5

5-7 899 868.5 32 9.5 340 36.8 I0.9 25.97-10 971 914.5 26 11.7 220 28.4 12.8 15.6

10-15 881 824.5 19 10.9 1’74 23.0 13.2 9.815-20 420 391.0 6 6.4 94 15.3 16.4 #

*Basis of expected deaths: U. S. Decennial Life Tables 1989-91.# Observed rate less than expected.

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