Norwegian Melanoma Registry
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3250 Norwegians were diagnosed with melanoma in 2024. New medical treatment for the patient group with melanoma spread appears to have a long-lasting effect.
Summary from the annual report 2024
The National Clinical Registry for Melanoma publishes national results for cutaneous melanoma, at institutional level, for the twelfth time in this annual report. The registry has data on melanoma cases for the period 2008–2024, but The Melanoma Registry was first given granted national status in 2013.
In 2024, 3250 cases of melanomas were registered, of which 3129 were cutaneous melanomas. Furthermore, 84 cases of eye melanoma and 37 mucosal melanomas. Cutaneous melanoma is the most serious form of skin cancer and is among the cancers that are increasing the most in Norway.
The coverage rate for clinical reporting in 2024 is 82.8 %. This is very encouraging as one of the registry’s quality goals is a coverage rate of at least 80 %, and for several years we have focused on increasing reporting from the hospitals. Various measures to improve the reporting rate have resulted in an improvement, especially that of establishing local contacts at the hospitals. It takes time to establish good reporting routines, and this will still be a focus area for the melanoma registry in the years to come.
The proportion of patients with pathologically free margins after primary excision is 71.7 % among the general practitioners (GPs) (fig. 2.9), in comparison it is 87.8 % in hospitals (fig. 2.10). The expert group believes that a desirable level is ≥ 85 %. The largest patient group removes their melanoma at GPs and private clinics, and the results for GPs are far below the desirable level. Some hospitals are planning to have, or have had, training for general practitioners . We hope that this will increase the level of knowledge about melanomas at GPs and private clinics, and to strengthen dermatologist resources in Norway. These are important measures both for early detection of melanoma, and to increase the rate of correctly performed primary excision.
An important quality goal to prevent local recurrence is that patients who undergo extended excision have the melanoma removed with a sufficient margin of healthy tissue as described in the National Treatment Guidelines. In Norway, this proportion is now within a high target of 91.5 % (fig. 2.11). There may be several reasons why melanoma is removed with more or less margin around the suspected lesion than the guidelines state. An example could be that the melanoma is in an area where removing a lot of skin and tissue would compromise function and aesthetics, such as in the head and neck region. We see that there is great variation between hospitals, and the registry has contacted the hospitals that do not achieve the desired level.
The quality indicator for the proportion of patients who have had extended excision within 35 days after primary excision is 58.9 % in Norway. (fig. 2.13). The target was set at over 90 % in last year’s report, but has been changed to 80 % this year. This target is more in line with the target set in the package procedures. Several hospitals have already shown an increase in recent years after being made aware of their own results.
The expert group wants to monitor the quality of assessment and treatment of patients with metastatic melanoma. The proportion of patients in stages III and IV who were discussed in MDT meetings (multidisciplinary team) before treatment decisions show that there is some variation between hospitals. See figures 2.17 and 2.18.
In this year’s report, we present several new figures based on drug treatment for patients with metastases. Some examples of this are the proportion of patients who have received neoadjuvant treatment with complete pathological response (fig. 2.22), the proportion of patients over 74 years of age who have received adjuvant treatment (fig. 2.24), and drug tumor-directed treatment given to melanoma patients in the last eight weeks before death (fig. 2.25). We want to take a closer look at the figures in chapter 2.6.2 and plan to develop target numbers and new quality indicators.
It is beneficial for the patient to have the diagnosis made as early as possible – preferably in stage T1 – as these normally have very good survival after surgery alone. T1 is characterised by the melanoma being 1 mm or thinner. The Advisory Board has set a quality target that at least 60 % of the melanomas that are removed should be in stage T1. The results show that in Norway the proportion is 56.9 % (fig. 2.8).
This year’s report presents results on patient-reported outcome and experience measures for the fourth time. Last year, a new quality indicator was developed that shows the proportion of patients who were satisfied with the treatment they received at the hospital. It is pleasing to see that 90.7 % of the patients who responded to the population surveys were satisfied with the treatment provided (fig. 2.33).
The five-year relapse-free survival among patients in stages I and II is also very good, 82.6 % in Norway (fig. 2.36). As some relapses are only clinically verified, and not necessarily reported to the registry, we have linked data from the Norwegian Patient Registry, to ensure complete information.
The five-year relative survival among patients in stages IIB and IIC is within the high target level of 77.2 % (fig. 2.40). As expected, this result is almost unchanged from last year’s report, but we look forward to following developments for these stages where we hope for good medical treatment in the years ahead