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Comparative Study
. 2018 May:94:47-60.
doi: 10.1016/j.ejca.2018.02.003. Epub 2018 Mar 20.

The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: An international assessment

Andreas Stang  1 , Jürgen C Becker  2 , Paul Nghiem  3 , Jacques Ferlay  4
Affiliations
Comparative Study

The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: An international assessment

Andreas Stang et al. Eur J Cancer. 2018 May.

Abstract

Aim: The aim of this article was to provide worldwide, population-based incidence rates for Merkel cell carcinoma (MCC).

Methods: We included 11,576 cases from 20 countries for time trend analyses (1990-2007) and 11,028 cases (2.5 billion person-years) from 21 countries for the period 2003-2007 extracted from Cancer Incidence in Five Continents. We computed age-standardised incidence rates (World Standard population) per million person years and sex ratios of these rates. We estimated annual percentage changes (EAPCs) of the incidence and studied the association between geographic latitude and MCC incidence. We examined the body site distribution of MCC.

Findings: In the majority of populations, the incidence has increased over time (EAPC, men 2.0-21.0%; women 1.6-27.2%). Rate differences between 1995 and 2007 were typically small (men: 0.8-2.2; women: 0.2-1.7). The incidence was relatively stable in some populations (men: U.S. blacks, Japan, Norway, Denmark; women: Denmark, Norway, Sweden). Incidences from 2003 to 2007 were highest in Australia, New Zealand, the United States and Israel among men and in New Zealand, Australia, Ireland and the Netherlands among women. The incidence of MCC and melanoma among white non-Hispanic males in North America was positively associated with living closer to the equator. The proportion of MCC on the head was higher with advanced age. The head was a less likely primary site among blacks as compared with any other ethnicity.

Interpretation: Several countries showed increases in MCC incidence among white non-Hispanics over time. Latitude closer to the equator was associated with the MCC incidence in North American men, but barely in women, possibly due to occupational sunlight exposure patterns.

Keywords: Carcinoma; Epidemiology; Incidence; Merkel cell; Neuroendocrine; Registries.

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Conflict of interest statement

Conflict of interest statement

Andreas Stang received a speaker honorarium from MerckSerono. Jürgen C. Becker has received speaker honoraria from Amgen, MerckSerono and Pfizer and has received advisory board honoraria from Amgen, CureVac, eTheRNA, Lytix, MerckSerono, Novartis, Rigontec and Takeda; and he has received research funding from Boehringer Ingelheim, BMS and Merck-Serono. Paul Nghiem has received honoraria from EMD Serono, Pfizer and Merck for consulting work. His institution has received research funding from Bristol Myers Squibb. The other authors have no conflicts to declare.

Figures

Fig. 1
Fig. 1. Age-standardised (World Standard Population) annual incidence rates (per million person years) of Merkel cell carcinoma
Blue dots and blue trend line: men; red dots and red trend line: women; cases include cancers coded as Merkel cell carcinoma (ICD-O: M8247/3) or neuroendocrine carcinoma (ICD-O: M8246/3) with either topography codes of the skin (ICD-O: C44.0-C44.9) or topography codes suggesting a skin cancer (see methods). (For interpretation of the references to color/colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 1
Fig. 1. Age-standardised (World Standard Population) annual incidence rates (per million person years) of Merkel cell carcinoma
Blue dots and blue trend line: men; red dots and red trend line: women; cases include cancers coded as Merkel cell carcinoma (ICD-O: M8247/3) or neuroendocrine carcinoma (ICD-O: M8246/3) with either topography codes of the skin (ICD-O: C44.0-C44.9) or topography codes suggesting a skin cancer (see methods). (For interpretation of the references to color/colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 1
Fig. 1. Age-standardised (World Standard Population) annual incidence rates (per million person years) of Merkel cell carcinoma
Blue dots and blue trend line: men; red dots and red trend line: women; cases include cancers coded as Merkel cell carcinoma (ICD-O: M8247/3) or neuroendocrine carcinoma (ICD-O: M8246/3) with either topography codes of the skin (ICD-O: C44.0-C44.9) or topography codes suggesting a skin cancer (see methods). (For interpretation of the references to color/colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 2
Fig. 2
Age-standardised incidence rates (cases per million person-years) of Merkel cell carcinoma in the world, 2003–2007 (upper figure: men, lower figure: women). Esri, DeLorme Publishing Company, Inc., U.S. Central Intelligence Agency; Projection type: WGS 1984, Web Mercator (auxiliary sphere).
Fig. 2
Fig. 2
Age-standardised incidence rates (cases per million person-years) of Merkel cell carcinoma in the world, 2003–2007 (upper figure: men, lower figure: women). Esri, DeLorme Publishing Company, Inc., U.S. Central Intelligence Agency; Projection type: WGS 1984, Web Mercator (auxiliary sphere).
Fig. 3
Fig. 3. Degree of geographical latitude (absolute value), age-standardised incidence rate and sex ratios of Merkel cell carcinoma among 37 white non-Hispanic populations in Northern America, 2003–2007
Gray lines indicate 95% confidence limits of the flexibly modelled precision-weighted regression line; populations include 36 U.S. populations and Canada.
Fig. 4
Fig. 4. Sex-specific site distribution of Merkel cell carcinoma among 7.737 white non-Hispanic populations, 2003–2007
Unspecified sites (M: 13%, F: 9%), overlapping sites (M: 0.4%, F: 0.6%) and anogenital sites (M: 0.9%, F: 1.7%) were excluded.
See this image and copyright information in PMC

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