Skin Cancer in Wales: The background
The three most common forms of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. All of which are rising in incidence across the UK and Wales.
When evaluating the background of skin cancer, statistical recordings are separated into non melanoma skin cancers (NMSC) and melanoma skin cancer. NMSC accounts for 20% of all cancers and 90% of all skin cancers. (2)
It is estimated 147, 000 new cases of NMSC are diagnosed in the UK each year. NMSCs are largely under reported due to multiple lesions, all of which are not biopsied. NMSC accounted for 1,319 deaths across the UK in 2017. (2)
BCC is a NMSC, it is the most common type of cancer in the UK, with an average of 48,000 new cases registered a year in England between 2004 and 2006. It accounts for 80% of all skin cancers in the UK. The true burden is thought to be significantly underestimated due to most cancer registries not registering multiple BCCs in the same individual and not all BCCs are submitted for histology. The number of new cases per year is therefore more likely to be between 55,000 and 60,000, using estimates based on the assumed missed data. It is estimated that BCCs represents almost 80% of all skin cancers. The lifetime risk for getting a BCC in the white UK population is 33-39% for men and 23-28% for women.
The incidence of BCC is rising. The largest reported increase in incidence was seen in the 30–39 age group. Over the age of 55 more males than females get BCCs. The incidence rates of BCC increase with age in both genders. A combination of late diagnosis and inadequate treatment can result in tumours destroying important anatomical structures. Areas such as the head and neck particularly the nose, eye, ear and lip can be difficult to obtain a good cosmetic result possibly rendering the lesion inoperable. The cost burden of managing BCCs looking at the number of in-patient bed days can be equated to the number of in-patient bed days for management of malignant melanoma in England. (3)
Squamous cell carcinoma (SCC) is a non-melanoma skin cancer (NMSC). The incidence of SCC is rising. It is the second most common form of skin cancer in the UK. SCCs account for 20% of all diagnosed skin cancers. Studies show more men are affected by SCCs than women. The main aetiological factor is exposure to sunlight, therefore the incidence increases with age. Patients who have been exposed to UVB and PUVA used for psoriasis treatment have an increased risk of SCC. Patients with genetic factors such as xeroderma pigmentosum, albinism and epidermolysis bullosa can develop lesions at younger ages when compared to the background population. Those patients receiving immunosuppressive therapy are at risk of SCC, particularly more aggressive forms. Chronic inflammation such as leg ulcers and pipe smoking (causing continuous heat damage to the lips) increase the risk of SCC (4).
Melanoma is the third most common skin cancer in the UK. It accounts for more cancer deaths than all other skin cancers combined. A diagnosis of Melanoma leads to more years of life lost overall than many more common cancers. This can be seen due to rising incidence of Melanoma affecting younger adults. In the UK more than 900 adults aged under 35 are now diagnosed with melanoma annually. The number of melanoma diagnoses in all the following age groups have increased; 25-49s have increased by 70%, 50-59s have increased by 97%, in 60-69s have increased by 156%, in 70-79s have increased by 219%, and in 80+s have increased by 203%. (2)
The Welsh Cancer Intelligence & Surveillance Unit (WCISU) is the National Cancer Registry for Wales. WCISU recorded 2,390 cases of Melanoma in Wales 2013/15. In Wales, since 2001 rates of melanoma have been on the rise. Melanoma is the 7th most common form of cancer occurring in Wales, out of 34 recorded types of cancer 2013-15. Cancer incidence in Wales is generally higher in deprived areas, however the incidence of Melanoma is higher in less deprived areas. (5) At present there is no breakdown of NMSC data in Wales to comment on.
More information on the WCISU can be found here.
In the UK it is considered that around 4 in 10 of all cancer incidences could potentially be preventable (6)