A study unveiled during the European Academy of Dermatology and Neurology Congress 2023 has brought to light a significant observation: global mortality rates attributed to non-melanoma skin cancers now exceed those of melanoma.
Despite non-melanoma skin cancers generally having a lower fatality rate compared to melanoma, their widespread occurrence has led to a higher number of fatalities, as articulated by the study’s researchers.
The Prevalence of Non-Melanoma Skin Cancer
During the year 2020 is a matter of substantial concern. The global landscape witnessed an alarming total of nearly 1.2 million cases of non-melanoma skin cancer, while cases of melanoma numbered 324,635.
This statistical revelation underscores the formidable impact of non-melanoma skin cancers, constituting an astonishing 78% of all documented skin cancer cases and resulting in 63,700 fatalities worldwide. By comparison, melanoma contributed to 57,000 deaths during the same timeframe.
Understanding Non-Melanoma Skin Cancer
Non-melanoma skin cancer is characterized by its gradual development within the superficial layers of the skin. Predominantly, two distinct variants are encountered: basal cell carcinoma and squamous cell carcinoma.
These particular cancer types are generally characterized by a reduced propensity for metastasis to distant anatomical sites and are known to be comparatively more responsive to therapeutic interventions.
Notably, the researchers observed a noteworthy correlation between the incidence of skin cancer and specific demographic factors. Fair-skinned and elderly populations within the United States, Germany, the United Kingdom, France, Australia, and Italy have demonstrated an elevated susceptibility to skin cancer.
Curiously, despite the higher incidence, these regions exhibit relatively lower mortality rates. It is also of significance that countries with a relatively higher representation of individuals with darker skin tones are not immune to the risks associated with skin cancer.
Dr. Michele Green, a renowned cosmetic dermatologist affiliated with Northwell Lenox Hill Hospital in New York City, offered her insights on the study’s findings, despite not being directly involved in the research.
Dr. Green astutely noted that the presence of dermatologists in a particular geographical region did not demonstrate a discernible correlation with the incidence or mortality rates of melanoma, suggesting that additional variables play a pivotal role in reducing the ratios of mortality to incidence.
Furthermore, Dr. Green expressed a sense of astonishment at the notably elevated mortality rate associated with non-melanoma skin cancers. This is a rather unexpected revelation, given that melanoma is traditionally regarded as the most lethal form of skin cancer.
This underlines the critical importance of regular consultations with dermatologists. Early detection and timely therapeutic interventions are paramount, as they have the potential to avert the progression of non-melanoma skin cancers to life-threatening stages.
The Surge in Non-Melanoma Skin Cancer Incidence
Dr. Brian Toy, an accomplished dermatologist holding positions as an attending dermatologist at Providence Mission Hospital and a clinical professor at the University of Southern California, highlights the historical context of skin cancer.
Melanoma, traditionally, presented a more significant risk of mortality when compared to non-melanoma skin cancers like basal cell carcinoma and squamous cell carcinoma. Despite significant therapeutic advancements in managing advanced melanoma through immunotherapy, this distinction remains valid today.
The study discerns that the escalated mortality rates linked to non-melanoma skin cancers primarily stem from the substantial volume of non-melanoma skin cancer cases, numbering at 1,198,073.
In stark contrast, melanoma cases stand at 324,635. Dr. Toy aptly likens this disparity to the contrast between fatalities involving automobiles and motorcycles. While statistics may indicate a higher risk with motorcycles, the larger number of automobile-related deaths is a direct consequence of the greater number of individuals driving cars.
Notably, regular consultations with a dermatologist emerge as a pivotal factor in influencing mortality rates. Early detection facilitated through routine visits significantly contributes to averting the transformation of non-melanoma skin cancers into life-threatening conditions.
Numerous determinants underlie the escalating incidence and mortality rates of non-melanoma skin cancer. To begin, a rapidly aging global population confronts an elevated level of UV radiation exposure, consequently elevating the susceptibility to skin cancer.
Secondly, the diminishment of the ozone layer, a natural protective shield against UV radiation, has compounded this vulnerability.
Dr. Toy has astutely observed that, within the United States, a prevailing lack of public awareness pertaining to the indications and manifestations of skin cancer persists, unless individuals have either personally encountered or witnessed its deleterious consequences.
This stands in marked contrast to nations such as Australia and New Zealand, characterized by a higher prevalence of skin cancer due to their substantial populations of fair-skinned individuals residing in sun-drenched environments.
This, in turn, has fostered a more comprehensive awareness of the condition. Elevating the scope of awareness campaigns, involving dermatologists, general practitioners, and diverse healthcare providers, is deemed instrumental in the management and amelioration of the impact of non-melanoma skin cancer.
Treatment Modalities for Non-Melanoma Skin Cancer
The approach to treating non-melanoma skin cancer is highly contingent on variables encompassing the cancer’s location, dimensions, and specific type. Dermatologists are typically well-equipped to manage non-melanoma skin cancer effectively.
However, when the malignancy presents with deeper infiltration or distant metastasis, the engagement of an oncologist may become warranted.
Within the spectrum of surgical interventions, two primary techniques stand out: excision surgery and Mohs surgery. Excision surgery entails the comprehensive removal of the affected area, followed by the submission of a biopsy to the laboratory for meticulous evaluation to ascertain the cancer’s complete eradication.
In contrast, Mohs surgery is a meticulous process, involving the progressive removal of the lesion layer by layer. Each extracted layer undergoes thorough examination by a skilled pathologist to detect any residual abnormal cells. This process iterates until the examination reveals the absence of anomalous cells in the tissue, ensuring the comprehensive excision of the cancer.
In instances where surgical intervention is not deemed a suitable course of action, healthcare providers may proffer alternative therapeutic strategies, such as curettage and electrodesiccation or cryosurgery.
The procedure of curettage and electrodesiccation involves the meticulous removal of the lesion’s surface layers through the utilization of a curette, succeeded by the application of a hyfrecator to cauterize any residual abnormal cells.
On the other hand, cryosurgery encompasses the application of liquid nitrogen to induce the cryogenic freezing of superficial lesions. This intervention may be conducted as an independent procedure or subsequent to curettage and electrodesiccation, as warranted.
An additional treatment avenue for basal cell carcinomas involves the application of topical cream treatment employing fluorouracil. Fluorouracil exerts its therapeutic action by disrupting the cellular division of abnormal cells, ultimately instigating programmed cell death.
The significance of non-melanoma skin cancer awareness, along with the early detection and prompt initiation of treatment, cannot be overstated in the ongoing battle against the escalating global mortality attributed to this condition.
The amplification of educational initiatives, featuring the active participation of dermatologists, general practitioners, and a spectrum of healthcare providers, coupled with the continuous evolution of treatment modalities, is poised to assume a pivotal role in mitigating the morbidity and mortality rates entwined with non-melanoma skin cancer.