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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.81 no.5 Rio de Janeiro Sept./Oct. 2006
In the past decades, the cutaneous melanomas (CM) have shown increased incidence in several developed countries and, in some of them, the mortality rates tend to stabilize. In Brazil, there has been an increased incidence, as well as an increase in mortality rates, which is better demonstrated in certain subpopulation groups.
In Rio Grande do Sul, for instance, estimated data of the INCA, in 2005, demonstrated that the incidence of cutaneous melanomas presented an over three-fold increase in women and it almost doubled in men, in less than 20 years. By and large, the state capitals have more CM cases than inland. The estimated incidence for women in Porto Alegre, in 2005, was 10.32/100000 inhabitants, and it was slightly under the rates for English women, which was 11.2/100000, in 2000. On the other hand, these rates were exceeded by women in Florianopolis, with an incidence of 12.2/100000 inhabitants, in 2005.
Although these data point out to the importance of cutaneous melanomas in the scenario of cancers in Brazil, the real magnitude of the problem is unknown, mainly due to lack of compulsory notification, lack of central record for neoplasms and little attention paid to the problem in certain geographic areas because of low incidence of the malignancy and predominance of dark-skinned individuals.
The Brazilian population has a significant heterogeneity of skin types in each region of the country, resulting from variable participation of several ethnic groups. Therefore, it is reasonable that the epidemiology of melanomas differ according to the region studied, and it is important that every research aiming to map the characteristics of this tumor in different areas in Brazil, take into account the variety of skins found in the population.
Most studies published are based on hospital data, and related to researches carried out by groups interested specifically in neoplasms, and there are scarce population-based studies that could contribute to real knowledge of the problem in the country. Hence, the article by Sortino-Rachou AM, Curado MP and Latorre MRDO "Cutaneous melanoma: population- based study in Goiania, Brazil, from 1988 to 2000", published in this issue of the Anais Brasileiros of Dermatologia, is most welcome. It analyzes the incidence and mortality of CM, in a record with 96.6% of histopathologic confirmation, in that city in the Central Region of Brazil.
The study demonstrates incidences in both sexes that are much lower than those in the Southern Region, but it also shows a trend towards increase along time. The incidence is higher in women than in men, which is similar to what occurs in Southern Brazil, where melanomas are more frequent. This phenomenon might be related to cultural habits of excessive sun exposure for aesthetic purposes, which are common in the country.
It is worth noting that over 80% of pathologic reports did not present a morphological classification, nor other parameters considered for prognosis, thus indicating another problem, that is, lack of uniformity in CM laboratory records in the national territory.
Despite the increased incidence in Goiania, mortality rates seem to be stabilizing in women, likewise in other countries. This fact is not always observed in other Brazilian regions.
In conclusion, further population-based studies on different geographic regions of Brazil are required to assess the real magnitude of the problem and its repercussion for the public health system. Moreover, it is relevant to collect homogeneous and reliable data that fit specific population groups in the country, allowing comparison, statistical analyses and specific assessment of risk populations for cutaneous melanoma, so as to define policies that are appropriate for control and prevention of the disease.
The study by Sortino-Rachou et al. will definitely be an encouragement to conduct more population- bases investigations in different parts of this continental-sized country, resulting in more reliable knowledge about the epidemiology of cutaneous melanomas and in better possibilities for control and resolution.
Coordinator of the National Campaign on Prevention of Skin Cancer, of the Brazilian Society of Dermatology; Full professor of Dermatology at the Universidade Federal do Rio Grande do Sul (UFRGS)