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DermPath Update

Volume 2 Number 2 - June 26, 1996

SKIN CANCER STATISTICS:
The Epidemic Widens

There are about 1 million new skin cancers projected in the U.S. for 1996.1,2 Of these, 95% will be basal cell (BCC) and squamous cell carcinomas (SCC). There will be 38,300 new cases of malignant melanoma and 7,300 deaths from melanoma. In Tennessee, there will be at least 910 new melanomas and 170 deaths.3 These figures are in all likelihood underestimated. Many skin cancers, including melanoma, are treated in physicians' offices and these cases are never entered into cancer registries. The rising skin cancer rates are being witnessed worldwide and are expected to increase over the next 10 to 20 years.2

The risk for developing melanoma in the U.S. in 1930 was about 1 in 1500. In 1996, the risk is 1 in 87 (1 in 70 for white men). By the year 2000, it is expected to be 1 in 75. The incidence of melanoma has been rising 6% annually. Along with the increase in incidence, survival has improved. In 1950, the survival of stage I melanoma was 50%. It is now about 90%. However, despite the enhanced survival there are more deaths from melanoma (2% increase per year). The overall incidence of melanoma is increasing faster than any other potentially lethal malignancy. The rising rates of melanoma are: 1) Not due to increased surveillance, 2) not due to better cancer-counting methods, 3) not due to changes in histologic diagnostic criteria, 4) noted worldwide.2

We have seen more skin cancers of all types in our laboratory. In the past year, we have seen 49 (29%) more melanomas, 351 (20%) more SCC and 493 (17%) more BCC than in the year before. Non-melanoma skin cancers are reported to be increasing 7-8% annually.4 Some areas of the world have witnessed the incidence of SCC to rise faster than that of BCC. In London, the rates for SCC increased 10 fold and the rates for BCC increased 3 fold between 1970 and 1992.5

The growing epidemic of skin cancer is attributed to an enlarging susceptible population and exposure to ultraviolet (UV) radiation.6 The incidence of skin cancer increases with age, and our population is aging. The majority of patients with skin cancer are over 55 years (95% are between 40 and 79 years). However, melanoma is one of the more common types of cancer effecting young adults. Also, the frequency of non-melanoma skin cancer in young adults is increasing. Between 2% and 5% of BCC occur before age 35.7 We are seeing more melanomas, basal cell carcinomas and squamous cell carcinomas from patients in their 20's, 30's and 40's, respectively.

There is concern that atmospheric changes may be allowing more UV to reach the earth's surface. Regardless, there is extensive UV radiation to people seeking a suntan and to those who are inadequately protected from sunlight. About 60% of adults younger than 25 seek a tan.8 Only 1 in 3 of these uses sunscreen. In 1992, only 31% of U.S. adults limited their exposure to sun.

One only needs to visit the neighborhood pool, country club or beach to witness the lack of UV/sunexposure precautions.9 Sun tanning is still very popular, evidenced also by the ubiquitous tanning salons. There at least 42 tanning establishments listed in the Knoxville Yellow Pages.

The risk factors for skin cancers are listed below. Of note is the significant likelihood that a patient with a skin cancer will develop another skin cancer of the same or different type.10,11,12,13 Of patients with BCC and SCC, 45% develop a second tumor within 5 years.10,14 In melanoma patients, 5% will develop another primary melanoma within 5 years.13

PBG

RISK FACTORS FOR SKIN CANCER

Non-Melanoma Skin Cancer

Malignant Melanoma

Caucasian

Caucasian

Cumulative sun exposure (UV radiation)

Sun exposure

Light skin, sunburn easily

Light skin, hair, and eye color

Light hair, eye color

Changing mole

Family history of skin cancer

Numerous moles

Personal history of skin cancer

Dysplastic nevi

PUVA therapy

Congenital nevi

Radiation exposure

Childhood suburns, freckles

Immunosuppression

Family history of melanoma

Basal cell nevus syndrome (BCC)

Personal history of melanoma

Xeroderma pigmentosa

Personal history of non-melanoma skin cancer

Cigarette smoking (SCC)

  

 

REFERENCES

1 Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: Incidence. J Am Acad Dermatol 1994:30:774.

2 Rigel DS, Friedman RJ, Kopf AW. The incidence of malignant melanoma in the United States: Issues as we approach the 21st century. J Am Acad Dermatol 1996:34:839.

3 Cancer Statistics. CA Am Cancer Society 1996:46:8.

4 Green A. Changing patterns in incidence of non-melanoma skin cancer. Epithelial Cell Bio 1992:1(1):47.

5 Hughes JR, Higgins EM, Smith J, Du Vivier AW. Increase in non-melanoma skin cancer -- the King's College Hospital experience. Cl and Exp Dermatol 1995:20:304.

6 Marks R. An overview of skin cancers. Incidence and causation. Cancer 1995:75:607.

7 Cox NH. Basal cell carcinoma in young adults. Br J Dermatol 1992:127:26.

8 Sun struck. US News and World Report 1996:62.

9 Rhodes AR. Public education and cancer of the skin. What do people need to know about melanoma and nonmelanoma skin cancer? Cancer 1995:75:613.

10 Marghoob A, Kopf AW, Bart RS, Sanfilippo L, Silverman MK, Lee, P, Levy E, Vossaert KA, Yadav S, Abadir M. Risk of another basal cell carcinoma developing after treatment of a basal cell carcinoma. J Am Acad Dermatol 1993:28:22.

11 Karagas MR, Stukel TA, Greenberg ER, Baron JA, Mott LA, Stern RS. Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group. JAMA 1992:267:3305.

12 Marghoob AA, Slade J, Salopek TG, Kopf AW, Bart RS, Rigel DS. Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma. Screening implications. Cancer 1995:75:707.

13 Giles G, Staples M, McCredie M, Coates M. Multiple primary melanomas: an analysis of cancer registry data from Victoria and New South Wales. Melanoma Research 1995:5:433.

14 Johnson TM, Rowe DE, Nelson BR, Swanson NA. Squamous cell carcinoma of the skin (excluding lip and oral mucosa). J Am Acad Dermatol 1992:26:467.

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