Non-melanoma skin cancer (NMSC) causes more global deaths than melanoma, despite its lower severity, and dark skin phenotypes were found to be at risk, according to research presented at the recent European Academy of Dermatology and Venereology (EADV) Congress 2023.
Using data from the World Health Organization International Agency for Research on Cancer data, the researchers looked at global skin cancer epidemiology, focusing particularly on population risk profiles and impact of dermatologist density on incidence and mortality.
They found that in 2020, NMSC was responsible for 63,731 deaths compared to the 57,043 deaths recorded from melanoma during the same year. However, as NMSC is often underreported in cancer registries, they noted that these figures may be underestimated.
Commenting on the top-line results, lead author of the study, Professor Thierry Passeron, professor and chair of dermatology in the University Hospital of Nice, said: ‘Although NMSC is less likely to be fatal than melanoma skin cancer, its prevalence is strikingly higher. In 2020, NMSC accounted for 78% of all skin cancer cases, resulting in over 63,700 deaths. In contrast, melanoma caused an estimated 57,000 fatalities in the same year. The significantly higher incidence of NMSC has, therefore, led to a more substantial overall impact.‘
Mapping of the data also identified a higher skin cancer incidence in fair-skinned and elderly populations from the USA, Germany, UK, France, Australia and Italy. In Africa, 11,281 skin cancer deaths were registered, demonstrating that even countries with a higher proportion of dark phenotypes are at risk.
Overall, individuals who were at a higher risk of melanoma were the elderly (relative risk, RR = 8.5), organ transplant recipients (RR = 8.0) and those with xeroderma pigmentosum (RR = 2,000). Those who worked outside were also deemed to have greater risk of NMSC than melanoma.
Commenting further on these findings, Professor Passeron said: ‘We have to get the message out that not only melanoma can be fatal, but NMSC also. 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.‘
When it came to dermatologist density, there was no evidence to suggest having more dermatologists per capita could reduce mortality rates. The researchers found that countries with fewer dermatologists, such as Australia, the UK and Canada, exhibited low mortality-to-incidence ratios.
Professor Passeron continued: ‘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 healthcare practitioners, such as GPs, in the identification and management of this disease may partly explain their success. There remains huge opportunity worldwide to elevate the role of GPs and other healthcare professionals in this process and train them to recognise suspicious lesions early.
‘In alignment with this, there 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 at high risk, such as darker-skinned populations.’
NMSC has become a significant public health threat with a 2022 study showing that the incidence rate increased from 54.08 per 100,000 population in 1990 to 79.10 per 100,000 in 2019.
