- Non-melanoma skin cancers accounted for more deaths worldwide than melanoma because they are much more common.
- The growing aging population could be one reason skin cancer rates are increasing.
- Non-melanoma skin cancer is treatable and, in most cases, preventable.
A study being presented at the European Academy of Dermatology and Neurology Congress 2023 reports that there are now more global deaths from non-melanoma skin cancers than melanoma itself.
Although non-melanoma skin cancers are less deadly than melanomas, their prevalence is so high that the number of deaths is higher, the study authors wrote.
In 2020, there were nearly 1.2 million cases of non-melanoma skin cancer worldwide compared to 324,635 cases of melanoma.
The researchers stated that in 2020, non-melanoma skin cancers accounted for 78% of all skin cancer cases and 63,700 deaths worldwide. During the same time, melanoma resulted in 57,000 deaths.
Non-melanoma skin cancer develops slowly in the upper layers of the skin.
Common types are basal cell carcinoma and squamous cell carcinoma.
These types of cancers are less likely to spread to other areas of the body and are more easily treated.
The study authors reported there is a high incidence rate of skin cancer in fair-skinned and elderly populations in the United States, Germany, the United Kingdom, France, Australia, and Italy, although death rates remain relatively low.
The researchers note that even countries with a high proportion of dark-skinned people are not immune to the risk of skin cancer.
“This study provides a fascinating insight into global skin cancer incidence and mortality rates. Interestingly, dermatologists’ availability within a given area had no correlations with melanoma incidence or mortality rates, suggesting that other factors besides dermatologist density successfully decrease mortality-to-incidence ratios,” said Dr. Michele Green, a cosmetic dermatologist at Northwell Lenox Hill Hospital in New York City who was not involved in the study.
“It is also surprising to see how high the mortality rate for non-melanoma skin cancers is, as most would assume melanoma to be the most lethal skin cancer type,” Dr. Green told Medical News Today.
“Historically, melanoma has a much higher risk of death than non-melanoma skin cancer such as basal cell carcinoma and squamous cell carcinoma, which are generally not life-threatening,” said Dr. Brian Toy, a dermatologist as well as an attending dermatologist at Providence Mission Hospital and a clinical professor in the School of Medicine at the University of Southern California who was not involved in the study.
“This remains true even today, despite significant advances in treating advanced melanoma with immunotherapy, which has largely replaced traditional chemotherapy,” Toy told MNT. “Immunotherapy has greatly increased the survival rate of patients with even metastatic melanoma.”
“In this study, the absolute number of patient deaths attributed to non-melanoma skin cancer did exceed those with melanoma, but that is only because the sheer number of non-melanoma skin cancers (1,198,073) far exceeded the number of melanomas (324,635).
An analogy would be to look at the number of deaths due to automobiles vs. motorcycles. Even though riding a motorcycle is statistically more dangerous, there are more automobile deaths per year because so many more people drive cars than riding motorcycles. People should routinely see a dermatologist. During regular visits, the doctor looks for non-melanoma skin cancers and recommends early treatment, which can prevent them from becoming life threatening.”
— Dr. Brian Toy, dermatologist
Green said there are a few reasons why non-melanoma skin cancer incidence and mortality rates are increasing. Among them:
- The growing age of the global population. As we age, we accumulate UV radiation exposure, increasing the risk of developing skin cancer.
- The depletion of our ozone layer is another reason. The ozone layer provides a protective layer to our atmosphere by absorbing UV radiation.
“Patients in the United States are generally unaware of the signs and symptoms of skin cancer unless it has personally affected them, their friends, or their family members,” Dr. Toy said.
“There is much more awareness in countries with an epidemic of skin cancer, such as Australia and New Zealand, where the incidence is exceedingly high due to the sheer number of fair-skinned people living in a sunny climate.”
The study authors suggest increasing awareness campaigns to educate the general public on risk factors can help. Programs should include dermatologists, general practitioners, and other healthcare providers to help manage the disease.
The study provides worldwide incidence and death rates, including areas with much higher rates than the United States. It also lumps many types of non-melanoma skin cancer together, points out Dr. Trevan Fischer, a surgical oncologist and assistant professor of surgical oncology for Saint’s John’s Cancer Institute at Providence Saint John’s Health Center in California, who was not involved in the study.
“Other types of skin cancer that are very rare but can be aggressive include Kaposi sarcoma and Merkel cell cancer. These were lumped in with the non-melanoma cancers, increasing the death rates. Basal cell and squamous cell carcinomas have a much lower death rate,” Fischer told MNT.
“The other question regarding death rates is, did the patients die from the skin cancer or another health condition, but they had skin cancer?
For example, if someone had a kidney transplant and then has a heart attack and dies, did they die from kidney disease, or did they die from a heart attack while having kidney disease? These are two different things.”
— Dr. Trevan Fischer, surgical oncolgist
Treatment varies depending on the location, size, and type of skin cancer.
Dermatologists can treat most cases of non-melanoma skin cancer except when the tumor is deep or has spread to other body areas. Then, an oncologist is usually consulted.
“Two surgical options for treatment include excision and Mohs surgery,” Dr. Green said.
“During excision surgery, the area is numbed, and a biopsy is removed and sent to a laboratory to ensure no remaining cancer is left. Mohs surgery involves the removal of the lesion one layer at a time. As a layer is removed, a pathologist reviews the layer for abnormal cells, and the process is repeated until no abnormal cells are present in the tissue.”
“If surgery is not an option, your provider may recommend curettage and electrodesiccation or cryosurgery for treatment. Curettage and electrodesiccation involve using a curette to scrape the lesion’s surface, followed by a hyfrecator to burn the remaining lesion. Cryosurgery uses liquid nitrogen to freeze superficial lesions and may be done as an independent treatment or following curettage and electrodesiccation.”
— Dr. Michele Green, cosmetic dermatologist
“Additionally, providers may treat some basal cell carcinomas with a topical cream called fluorouracil, which disrupts cell division of the abnormal cells, causing the cells to die,” Green said.