Skin cancer twice as bad as previous estimates

Reseach shows one type accounts for 200,000 operations a year with cases rising 80 per cent in a decade

Skin cancer is now nearly as prevalent as all other cancers put together, with more than 200,000 basal cell skin cancers treated with surgery a year. New research has found that, over the past decade, there has been an 80 per cent rise in cases of the skin cancer which are treated with surgery alone. But doctors who carried out the study warn that official government skin cancer figures seriously underestimate the true levels. With costs of treating each case of this form of skin cancer estimated at around £1,000, the financial burden to the NHS could be more than £200m a year.

"Our study shows that the number of basal cell carcinomas (BCC) in the UK is approximately twice that indicated by government statistics," said doctors from Norfolk and Norwich University Hospital NHS Foundation Trust and Eastern Cancer Registration Centre, Cambridge, who carried out the study. "The effects on population health and on costs to the health services of BCC in the UK should be recognised. Resources to prevent, diagnose and manage the disease should be prioritised to help control BCC, which now appears to be the commonest malignant disease in the UK."

They added: "Cancer registries acknowledge that data collection for BCC is imperfect, and consequently data on BCC are excluded from national statistics. Unfortunately, this means that the commonest cancer in the UK is often overlooked by politicians, the public and the media."

Catherine Thomson, of Cancer Research UK, said: "Basal cell carcinoma is the most common type of skin cancer and we need to find better ways of recording the number of people diagnosed with it. This means they are not routinely reported and the true workload and treatment burden on the NHS is not widely understood. The good news is that generally it's one of the easiest forms of cancer to treat and it is rarely fatal."

BCC, which accounts for around 75 per cent of all skin cancers, develops in the outermost layer of the skin, the epidermis, and it is linked to overexposure to ultraviolet light. Surgery is the main treatment and involves removing the cancerous tumour and some of the surrounding skin. Treatment for BCC is completely successful in approximately 90 per cent of cases, and unlike melanoma skin cancer, which is linked to around 2,000 deaths a year, it is rarely fatal.

However, projected government figures obtained by The Independent on Sunday show that melanoma cases are also expected to rise dramatically. The Department of Health strategy paper, which outlines a "vision" of how skin cancer in the UK might develop by 2015, reveals that medical advisers working in 2010 anticipated a significant increase in cases. "If current trends continue, it is anticipated that there will be around 15,500 cases of melanoma diagnosed per year within the next 15 years," it warns. Non-melanoma skin cancers (NMSC) of which BCC are a type, were also projected to increase by the paper, which said: "Similarly, the incidence of NMSC is set to increase over the next five years due to factors including an ageing population and a general increase in UV radiation exposure of the skin through altered behaviour."

According to the new study, cancer registries have difficulty in collecting and dealing with data on the incidence of BCC because of the sheer volume of work and the complexity of accurately identifying cases. The main aim of the research was to estimate the number of cases of BCC requiring surgical treatment in the UK each year.

This is corroborated by the government paper from 2010, which said: "Progress in improving national skin cancer registration has been slow. Better data (including data on co-morbidity, staging and performance status) is essential for informed cancer service planning, evaluation of prevention strategies and improved management of patients"

The team from East Anglia used data from the eastern registry to estimate the incidence of skin cancer and how it has changed over a decade. Results show that over the 11-year study, the number of patients with surgically treated BCC increased by 81 per cent. The team then extrapolated the findings to the UK population to estimate that around 200,000 patients had 247,000 cases of BCC treated surgically. The researchers say these may be underestimates because BCC is treated with other therapies too, including cryotherapy, chemotherapy, and radiotherapy. That compares with around 114,000 non-melanoma skin cancers which are registered annually in England and Wales.

In all, around 300,000 cancers a year, excluding non-melanoma skin cancers, are registered in the UK, which means, they say, that BCC is nearly as common as all other cancers combined.

"We found a far higher incidence of BCC in our analysis than is stated by the cancer registries, implying that BCC is far more common than previously thought.

"BCC occurs predominantly on sun-exposed areas of elderly people with lighter skin. Elderly people with paler skin should be strongly encouraged to avoid excess exposure to UV. Cancer registries should be supported to record more accurately the incidence of BCC."

Dr Bav Shergill, consultant dermatologist at Brighton and Sussex University Hospitals NHS Trust, said: "This is an interesting study that suggests the incidence of skin cancer may be substantially higher than was thought. As dermatologists, we are seeing more cases of skin cancer, especially BCC. It is a challenge because the numbers of cases are projected to keep on increasing. It is thought that this is due to a number of factors, including people living longer, and greater exposure to the sun through outdoor hobbies, travel and package holidays, and so on."

Degrees of danger

Three types of skin cancer are prevalent.

Basal cell carcinoma is the most common form. It is slow growing and almost never spreads to other areas of the body. If treated in the early stages of growth it is usually completely curable.

Squamous cell carcinoma is the second most common form in the UK, making up one in five diagnosed skin cancers. It is treatable in the early stages through surgery.

Malignant melanoma is a malignant tumour and is usually fast growing. Approximately 11,000 people will be diagnosed with this type annually. It must be treated in the early stages. Tumours can require extensive surgery, chemotherapy and/or radiotherapy.

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