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When it comes to skin cancer, forms like basal cell and squamous cell may seem less concerning than melanoma, since they rarely spread (or metastasize) to other parts of the body.
A new study, however, has found that nonmelanoma cancers are killing more people than melanoma — even though melanoma is deadlier on an individual basis.
The research, presented October 11 at the European Academy of Dermatology and Venereology (EADV) Congress 2023 and yet to be published in a medical journal, points out that more nonmelanoma deaths are occurring because there are far more cases.
“Although those nonmelanoma skin cancers are much less deadly as compared to melanoma, their high number explains a higher mortality,” says the lead study author, Thierry Passeron, MD, PhD, a professor and the chair of the department of dermatology at the Université Côte d’Azur in Nice, France. “Awareness and detection campaigns have mainly focused on melanoma to date.”
Results Backed by Global Data
Using WHO International Agency for Research on Cancer (IARC) data, Dr. Passeron and his team calculated that nonmelanoma cases totaled nearly 1.2 million in 2020. These incidents accounted for 78 percent of all skin cancer cases and resulted in 63,700 deaths.
Melanoma, on the other hand, caused almost 325,000 skin cancers and led to more than 57,000 deaths. Even though nonmelanoma cancer caused 6,700 more deaths, about 17.5 percent of melanoma cases resulted in death, compared with 5 percent of nonmelanoma cases.
Passeron adds that nonmelanoma cancers are probably underreported, as many go unrecorded in cancer registries.
“I think that the research reinforces the need to be aware of all different kinds of skin cancer,” says Jeffrey Weinberg, MD, a dermatologist at Mount Sinai Health System in New York City. “Many individuals do not even know the difference between the various types.”
What Are the Different Types of Skin Cancer?
As the American Cancer Society explains, melanoma (“black tumor”) develops when melanocytes (the cells that produce pigment and give skin its color) grow out of control. Melanoma makes up only about 1 percent of all skin cancers.
Nonmelanoma cancers develop in skin cells other than melanocytes. These include squamous cell carcinoma and basal cell carcinoma, which is the most common of all skin cancers.
There are a few other nonmelanoma cancers that account for less than 1 percent of skin cancers, such as Merkel cell carcinoma, which can be up to five times more deadly than melanoma, according to the Skin Cancer Foundation.
“I think that we’ve focused on promoting melanoma awareness for so long that many people don’t realize that nonmelanoma skin cancers exist and are harmful,” says Lauren Ploch, MD, a dermatologist in Augusta, Georgia. “For example, when Jimmy Buffett passed away from skin cancer, most people assumed that he passed away from melanoma. He unfortunately passed from a very aggressive type of nonmelanoma skin cancer called Merkel cell carcinoma.”
If caught early, however, even skin cancers that are more aggressive can be successfully treated.
Black and Asian People Aren’t Immune to Skin Cancer
While the study revealed a significant incidence of skin cancer among fair-skinned and elderly populations in the United States, Germany, the United Kingdom, France, Australia, and Italy, it also emphasized that nations with a high percentage of dark-skinned individuals were not immune.
Skin cancer may be less common in Africa and Asia, but the probability of dying from it was high in these regions, according to the findings. The research cited more than 11,000 skin cancer deaths in Africa in 2020.
Darker skin may provide some additional defense against sun-related cancer, but Dr. Weinberg warns there is still risk.
“People with darker skin sometimes assume they are less prone to skin cancer because of the pigment in their skin,” he says. “This is true to some extent, but it is not absolute.”
In Passeron’s view, health awareness campaigns have mainly focused on the detection of skin cancers in fair-skinned populations.
“Individuals with melanin-rich skin are also at risk and are dying from skin cancer,” he says. “Prevention with sun protection and education regarding suspicious lesions is of utmost importance to all populations. Efforts should also extend to populations that may not typically be considered at high risk, such as darker-skinned populations.”
Other groups at high-risk for skin cancer include outdoor workers, organ transplant recipients, and individuals with xeroderma pigmentosum (an inherited condition characterized by extreme sensitivity to ultraviolet radiation), according to the analysis.
Healthcare Professionals May Play a Bigger Part
It might be expected that countries with more dermatologists per person would have lower skin cancer mortality rates, but to the surprise of the researchers, this was not the case. They noted that countries such as Australia, the United Kingdom, and Canada, with fewer dermatologists, exhibited low death-to-cancer incidence ratios. Japan, Russia, and Argentina, meanwhile, recorded a high number of deaths despite having a high density of dermatologists.
The scientists suggest that in some countries that have fewer dermatologists per capita, general practitioners may be playing a larger role in identifying and treating skin cancers. In many countries, general practitioners are able to do a full skin exam of their patients annually, according to Dr. Ploch.
“If we assume that many people are more likely to just see a general practitioner, the education of these providers [such as training them to recognize suspicious lesions early] will be essential to the goal of managing skin cancer in the population,” says Weinberg.
Considering that both nonmelanoma and melanoma skin cancers can be life-threatening, the American Academy of Dermatology urges the public to learn the possible signs of skin cancer, how to examine yourself, and what steps you can take to lower your risk.
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