Epidemiology of skin cancer in the mature patient

Publication date: Available online 13 October 2017
Source:Clinics in Dermatology
Author(s): Vivien Lai, William Cranwell, Rodney Sinclair
Epidermal cancers include keratinocyte cancer, melanocyte cancer and Merkel cell carcinoma. These cancers account for the vast majority of new cancer diagnosed in Australia, North America and Europe. Keratinocyte cancer is the most common epidermal cancer and accounts for 7 out of 8 new cancers diagnosed in Australia. Melanoma and Merkel cell carcinoma are less common than keratinocyte carcinoma but are more important causes of mortality in Australia. Keratinocyte cancer has also been demonstrated to be a marker of cancer-prone phenotype. Risk factors for epidermal cancer include intrinsic and environmental factors, in particular exposure to ultraviolet radiation and advanced age. Actinic keratosis has an approximate prevalence of 79% of men and 68% of women between the ages of 60 to 69years, and has a low risk of malignant transformation into in squamous cell carcinoma. Basal cell carcinoma is the most common malignancy in Caucasians worldwide, with the incidence increasing by 2% per year in Australia. In 2010, the incidence of BCC in Australia was 1541 per 100,000 persons. Squamous cell carcinoma is the second most common epidermal cancer, with an incidence of approximately 1035 or 472 per 100,000 person years in males and females respectively. Primary risk factors for both BCC and SCC include light skin color, UV radiation exposure and chronic immunosuppression. Although the rate of melanoma is increasing, the mortality in Australia is reducing and is currently 9%. The overall incidence of melanoma in Australia is approximately 50 cases per 100,000 persons (62 for males and 40 for females). Keratinocyte carcinoma and melanoma are risk factors for developing further skin cancer and primary malignancy. This article reviews the incidence, prevalence and risk factors associated with the development of epidermal cancer and pre-malignant epidermal neoplasia.