Completeness of data on malignant melanoma skin sites and morphology in Croatian National Cancer Registry 2000-2014: an overview of recent progress

Jelena Barbarić, Jan Willem Coebergh, Mario Šekerija


Mortality rates and five-year relative survival for malignant melanomaMM of the skin in Croatia are poor compared with most Europeancountries. Epidemiological data recorded at the National Cancer Registry(CNCR) are used for informing various decision-makers and researchers, aswell as comparisons with other countries. We analyzed CNCR data on MMskin sites and morphology for 2000-2007 and 2008-2014 and comparedthem with European 2000-2007 data. We further stratified skin site analysesin Croatia by sex, different age groups, and sources of reports. We found 52%of case with “non-specified sites” in Croatia in 2000-2007; however, that ratiodecreased to 36% in 2008-2014, with 29% of registered MM cases occurringon the trunk, 22% on the limbs, and 13% on the head and neck. The ratio of“non-specified sites” cases in reports originating from university hospitalsdecreased by 25% and by 9.2% in those from general hospitals. The ratioof “not otherwise specified” among histologically verified cases decreasedfrom 96% in 2000-2007 to 84% in 2008-2014. Our results reveal a substantialratio of inadequately reported cases, in particular when compared to data atthe European level, where in 2000-2007 only 7.7% of cases were from “nonspecifiedsites” and 19% were of non-specified morphology. Irrespective ofrecent progress, the proportion of unspecified cases still hampers insight into sitedistribution by subgroups. A further increase in the overall completeness ofMM data within CNCR is needed to enable research-informed improvementof melanoma control in the country. Our findings call for engagement ofall stakeholders in optimization of the national melanoma registration processesand using models such as RegisTree to facilitate these initiatives.


Crocetti E, Mallone S, Robsahm TE, Gavin A, Agius D, Ardanaz E, et al. Survival of patients with skin melanoma in Europe increases further: Results of the EUROCARE-5 study. Eur J Cancer. 2015 Sep 5. pii: S0959-8049(15)00745-5. doi: 10.1016/j.ejca.2015.07.039. [Epub ahead of print]

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: (accessed February 8, 2016)

Barbarić J, Šekerija M, Agius D, Coza D, Dimitrova N, Demetriou A, et al. Disparities in melanoma incidence and mortality in South-Eastern Europe: Increasing incidence and divergent mortality patterns. Is progress around the corner? Eur J Cancer. 2016;55:47-55. doi: 10.1016/j.ejca.2015.11.019.

Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2016. Available from: (accessed February 8, 2016)

Coebergh JW, van den Hurk C, Rosso S, Comber H, Storm H, Zanetti R, et al. EUROCOURSE lessons learned from and for population-based cancer registries in Europe and their programme owners: Improving performance by research programming for public health and clinical evaluation. Eur J Cancer. 2015;51(9):997–1017.

Caini S, Gandini S, Sera F, Raimondi S, Fargnoli MC, Boniol M, et al. Meta-analysis of risk factors for cutaneous melanoma according to anatomical site and clinico-pathological variant. Eur J Cancer. 2009;45(17):3054–63.

Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R and Ferlay J (eds.). Cancer Incidence in Five Continents, Vol. X. Lyon: 2013

De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE--5-a population-based study. Lancet Oncol. 2014;15(1):23-34. doi: 10.1016/S1470-2045(13)70546-1.

Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977–1010.

Coebergh JW, van den Hurk C, Louwman M, Comber H, Rosso S, Zanetti R, et al. EUROCOURSE recipe for cancer surveillance by visible population-based cancer RegisTrees in Europe: From roots to fruits. Eur J Cancer. 2015;51(9):1050–63.

van der Leest RJT, de Vries E, Bulliard JL, Paoli J, Peris K, Stratigos AJ, et al. The Euromelanoma skin cancer prevention campaign in Europe: characteristics and results of 2009 and 2010. J Eur Acad Dermatol Venereol. 2011;25(12):1455–65.

Dummer R, Hauschild A, Lindenblatt N, Pentheroudakis G, Keilholz U. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26 Suppl 5:v126–32.

Vrdoljak E, Torday L, Sella A, Leyman S, Bavbek S, Kharkevich G, et al. Insights into cancer surveillance in Central and Eastern Europe, Israel and Turkey. Eur J Cancer Care. 2015;24(1):99–110.

Buljan M, Rajacić N, Vurnek Živković M, Blajić I, Kusić Z, Šitum M. Epidemiological data on melanoma from the referral centre in Croatia (2002-2007). Coll Antropol. 2008;32 Suppl 2:47–51.

Pavlović-Ruzić I, Jonjić N, Zamolo G, Zuvić-Butorac M, Katunarić M, Pečanić S. The patterns of melanoma presentation in Rijeka region. Acta Dermatovenerol Croat. 2013;21(3):174–9.

Hollestein LM, van den Akker S a W, Nijsten T, Karim-Kos HE, Coebergh JW, de Vries E. Trends of cutaneous melanoma in The Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989. Ann Oncol. 2012;23(2):524–30.

van der Leest RJT, Zoutendijk J, Nijsten T, Mooi WJ, van der Rhee JI, de Vries E, et al. Increasing time trends of thin melanomas in The Netherlands: What are the explanations of recent accelerations? Eur J Cancer. 2015;51(18):2833–41.

van der Leest RJT, van Steenbergen LN, Hollestein LM, de Vries E, Nijsten T, van Akkooi ACJ, et al. Conditional survival of malignant melanoma in The Netherlands: 1994-2008. Eur J Cancer. 2014;50(3):602–10.

Holterhues C, Hollestein LM, Nijsten T, Koomen ER, Nusselder W, de Vries E. Burden of disease due to cutaneous melanoma has increased in the Netherlands since 1991. Br J Dermatol. 2013;169(2):389–97.

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