Nonmelanoma skin cancer may be causing a greater number of global deaths than melanoma, according to findings presented by Salah et al at the European Academy of Dermatology and Venerology Congress 2023. Investigators also suggested that nonmelanoma skin cancer may be underreported and that the true impact of the disease may be higher than previously estimated.
Background
The most common types of nonmelanoma skin cancer, which develops in the upper layers of the skin, are basal cell carcinoma and squamous cell carcinoma. In comparison with melanoma, which develops in the melanocytes, nonmelanoma skin cancer may be less likely to metastasize and can be treated more easily.
“Although [nonmelanoma skin cancer] is less likely to be fatal than melanoma skin cancer, its prevalence is strikingly higher. In 2020, [nonmelanoma skin cancer] accounted for 78% of all skin cancer cases, resulting in over 63,700 deaths. In contrast, melanoma caused an estimated 57,000 [deaths] in the same year. The significantly higher incidence of [nonmelanoma skin cancer] has, therefore, led to a more substantial overall impact,” emphasized lead study author Thierry Passeron, MD, PhD, Professor and Chair of Dermatology as well as President of the Department of Clinical Research and Innovation at the Nice University Hospital. “As alarming as these figures are, they may, in fact, be underestimated. [Nonmelanoma skin cancer] is often underreported in cancer registries, making it challenging to understand the true burden,” he continued.
Study Methods and Results
In the new study, investigators used data from the World Health Organization International Agency for Research on Cancer to analyze the burden and outcomes of melanoma and nonmelanoma skin cancer cases. The investigators also identified specific populations that were more at risk of nonmelanoma skin cancer—including individuals who worked outside, organ transplant recipients, and those who had xeroderma pigmentosum.
The investigators found a high incidence of skin cancer among fair-skinned and elderly patients from the United States, the United Kingdom, France, Germany, Italy, and Australia. However, even countries with a high proportion of dark phenotypes were not immune to the risk of death from skin cancer, as demonstrated by the registered 11,281 deaths in Africa.
Further, the investigators reported that in 2020, there were nearly 1.2 million reported cases of nonmelanoma skin cancer across the world compared with 324,635 cases of melanoma.
“Our study did not find consistent evidence to suggest that having more dermatologists per capita could reduce mortality rates. Surprisingly, countries like Australia, the UK, and Canada—with fewer dermatologists—exhibited low mortality-to-incidence ratios. We therefore need to explore what strategies these countries are employing to reduce the impact of skin cancer in further depth. The involvement of other health-care practitioners such as [general practitioners] in the identification and management of this disease may partly explain their success. There remains huge opportunity worldwide to elevate the role of [general practitioners] and other health-care professionals in this process and train them to recognize suspicious lesions early,” Dr. Passeron highlighted.
Conclusions
“[T]here is an ongoing need to develop awareness campaigns that educate the general public about the risks of sun exposure and other relevant risk factors. These campaigns should be tailored to at-risk populations, including those with fair skin, outdoor workers, the elderly, and individuals who are immunosuppressed. Importantly, these efforts should also extend to populations that may not typically be considered … high risk, such as [individuals with darker skin tones]. It's crucial to note that individuals with melanin-rich skin are also at risk and are dying from skin cancer. There is a need to implement effective strategies to reduce the fatalities associated with all kinds of skin cancers,” underscored Dr. Passeron. “Skin cancers are preventable and treatable, so we need to do more to ensure we are stopping the progression of this disease as early as possible to save lives,” he concluded.
