DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com
Epidemiological trends in skin cancer Zoe Apalla1, Aimilios Lallas1, Elena Sotiriou1, Elizabeth Lazaridou1, Demetrios Ioannides1 1 First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Greece
Key words: skin cancer, melanoma, non-melanoma skin cancer, epidemiology Citation: Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept. 2017;7(2):1. DOI: https://doi.org/10.5826/dpc.0702a01 Received: September 4, 2016; Accepted: January 19, 2017; Published: April 30, 2017 Copyright: ©2017 Apalla et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Zoe Apalla, MD, PhD, Delfon 124, 54643, Thessaloniki, Greece. Tel. +302313308882. E-mail:
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ABSTRACT
Skin cancer, including melanoma and non-melanoma skin cancer (NMSC), represents the most common type of malignancy in the white population. The incidence rate of melanoma is increasing worldwide, while the associated mortality remains stable, or is slightly decreasing. On the other hand, the incidence for NMSC varies widely, with the highest rates reported in Australia. In the current review, we highlight recent global trends in epidemiology of skin cancer. We discuss controversial issues raised in current epidemiological data, we analyze the most important risk factors associated with the development of melanoma and NMSC and the impact of skin cancer on health care services. Furthermore, we underline the pressing need for improved registration policies, especially for NMSC, and lastly, we refer to the ongoing primary and secondary prevention strategies and their outcomes so far.
Introduction
Melanoma
Epidemiology, translated from Greek, literally means “the
Melanoma is much more common in whites than in other
study of population.” The main aims of epidemiology include
ethnic groups. Overall, the lifetime risk of developing mela-
the description of disease patterns in human populations, as
noma is about 2.4% in Caucasians, 0.1% in Blacks, and
well as the identification of causes of diseases. Epidemiology
0.5% in Hispanics [3]. The risk of melanoma increases with
provides essential data for the management, evaluation and
age. The average age at the time of diagnosis is about 60.
planning of services for prevention, control and therapeutic
Melanoma is approximately 1.5 times more frequent in males
management of diseases [1].
than females. It has been shown that the incidence rate does
Skin cancer represents the most common group of malig-
not significantly differ until the age of 40, however, after age
nant neoplasms in the white population. The incidence rate
75, the incidence becomes almost three times higher in males
of melanoma and non-melanoma skin cancer (NMSC) is
compared to females [4,5]. In addition, the frequency of its
increasing worldwide [2]. Therefore, studying and under-
occurrence is closely associated with the constitutive color of
standing their current epidemiological trends is considered
the skin and depends on the geographical zone [6].
crucial in order to achieve early and adequate control of the disease.
Review | Dermatol Pract Concept 2017;7(2):1
Cumulative epidemiologic data from Europe [7-10], Canada [11] and the United States [12-14] indicate a continuous
1
and dramatic increase in incidence during the last decades.
Indeed, very recent epidemiological studies indicate that
The highest incidence rates have been reported in New Zea-
melanoma in situ, with an annual increase of 9.5%, occupies
land with 50 cases per 100,000 persons and Australia with 48
a disproportionately high percentage of the overall mela-
cases per 100,000 persons (59 for males and 39 for females
noma increase. However, the combined melanoma incidence
in 2011), followed by the US (21.6 new cases per year per
(including both invasive and in situ melanoma) was also
100,000 in 2012) and Europe (13.2 and 13.1 new cases per
found to increase by 2.6% per year [20], justifying that the
year, per 100,000 for men and women, respectively) [15-17].
incidence increase also considers tumors with metastatic
The wide variation in incidence rates is not observed only
potential.
among different continents. Data from the European Cancer
From the dermatopathologic point of view, this is not
Observatory suggest significant variability among European
surprising, since there are studies suggesting a current trend
countries, too. Scandinavian countries (especially Sweden,
towards reclassification of prior non-malignant diagnoses as
with an estimated incidence of 23.9 in 2012), Switzerland and
melanoma [21].
Great Britain report the highest rates (>16.9 per 100,000 for
Furthermore, in a population-based study correlating
2012), whilst the Balkan countries, Moldova and Bosnia and
number of skin biopsies and incidence of melanoma, the
Herzegovina, are standing at the lower incidence levels (
