Invasive melanoma: survival and mortality in Brazil in hospital oncology referral center in Rio de Janeiro

O melanoma, a neoplasia cut??nea que apresenta a maior letalidade, apresenta tend??ncia de aumento incid??ncia nos ??ltimos 30 anos. Para sua carcinog??nese contribuem fatores relacionados aos indiv??duos tais como caracter??sticas de cor da pele e fotossensibilidade, e fatores ambientais, principalmente exposi????o ?? irradia????o ultravioleta. Esta disserta????o teve como objetivos avaliar aspectos relacionados mortalidade na popula????o brasileira e ?? apresenta????o cl??nica e ao tratamento do melanoma em centro de refer??ncia para o tratamento oncol??gico no Rio de Janeiro. Observou-se uma tend??ncia temporal de aumento na mortalidade no per??odo de 1980 a 2005 de 1,1 por cento ao ano, com taxas distintas de acordo com o sexo, faixa et??ria e regi??o geogr??fica estudada. A tend??ncia variou tamb??m segundo estes mesmos fatores, mostrando-se maior entre as mulheres (1,6 por cento ao ano) e nas regi??es Sul e Centro-Oeste; e foi distinta quando analisada durante todo o per??odo ou somente nos ??ltimos 10 anos da s??rie: neste ??ltimo per??odo a tend??ncia mostrou-se menor, com 0,6 por cento de aumento ao ano para todo o pa??s, entre os indiv??duos com 70 anos ou mais (3 por cento ao ano), entre as mulheres (1,6 por cento ao ano) e nas regi??es Sul e Centro-Oeste. Com rela????o a s??rie de pacientes oriundos do centro de refer??ncia oncol??gica tratados no per??odo de 1997 a 2004, quando comparados a s??ries internacionais observa-se uma maior propor????o de indiv??duos portadores de melanoma acrolentiginoso (21,3 por cento), relacionado ?? composi????o ??tnica da popula????o de refer??ncia do centro. Nesta coorte de pacientes a sobrevida global foi semelhante ??quela encontrada em outros pa??ses. Observou-se nesta popula????o uma associa????o positiva entre maior n??vel socioecon??mico, medido pela escolaridade, e maior sobrevida global (HR 0,741) e sobrevida livre de doen??a (HR 0,784). Conclui-se que o melanoma constitui um relevante problema de sa??de p??blica, onde interven????es de preven????o prim??ria devem ser encorajadas, e onde outros fatores al??m dos classicamente relacionados ao tumor e sua extens??o no organismo devem ser observados.Melanoma, the cutaneous neoplasm with higher lethality, presents with increasing incidence in the last 30 years. Classical factors contributing to its carcinogenicity are related to the characteristics of the host such as skin color and phototypes, and related to environmental exposures, especially ultraviolet irradiation. This study had as objectives to evaluate aspects related to temporal trends in mortality of melanoma in the Brazilian population, and aspects related to clinical presentation and treatment of melanoma at an oncology center in Rio de Janeiro. It was observed an increase in mortality in the period between 1980 and 2005 of 1.1% per year, the rates were different in according to sex, age groups and geographical regions. The temporal trends varied also in according to these same variables, it was higher among females (1.6% per year) and in the regions South and Central-West; the trends were distinct when only the last 10 years were analyzed: there was a decrease in the magnitude of increasing in mortality for the whole country (to 0.6% per year), among older people (over 70 years, 3.0% per year),among females (1.6% per year) and in the regions South and Central-West. With relation to the patients treated at the oncology center in the period between 1997 and 2004, as compared with international series, there was a larger proportion of patients with acrolentiginous melanomas (21.3%), a finding related to ethnic characteristics of the population treated at this center. In the cohort of patients, the overall survival was similar to that found at other countries, as analyzed by stage. In this population it was observed a positive association between higher socioeconomic level (as measured by school attendance) and better overall survival (HR 0.741) and relapse-free survival (HR0.784). In conclusion, melanoma is a relevant public health problem where interventions such as primary prevention may be encouraged, and where factors other than those related to the tumor and its extent in the host should be observed