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SKIN CANCER

Cancer
Statistics

August 2013

Contents

There are two types of skin cancer: malignant melanoma of the skin, and
non-melanoma skin cancer (NMSC). Malignant melanoma is the less common but most
serious type of skin cancer. In the UK in 2010, around 12,800 people were diagnosed with
malignant melanoma, and in the UK in 2011 around 2,200 people died from the disease.
NMSC is much more common, with more than 99,500 cases recorded in the UK in 2010;
registration of the disease is known to be incomplete, however. The vast majority of NMSC
cases are detected early and are not life-threatening. In the UK in 2011, there were around
590 deaths from NMSC.

1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Malignant melanoma is the fifth most common cancer in the UK, but only the 18th most
common cause of cancer death, reflecting high survival from the disease. More than eight
in ten malignant melanoma cases are estimated to be caused by UV radiation from the
sun and sunbeds. Incidence rates have more than quadrupled since the mid-1970s in
Great Britain. Most of the increase is considered to be real and linked to changes in sunrelated behaviour, such as an increase in frequency of holidays abroad over time. The
age distribution for malignant melanoma is unusual compared with other cancers, with a
relatively high proportion of cases in younger people; but still 45% of cases are diagnosed
in the over-65s. Whilst malignant melanoma is more common in females than males in the
younger age groups, this pattern reverses in older people.

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

By stage at
diagnosis

3.5

In Europe

4 Mortality

By country in
the UK

There are two types of skin cancer: malignant melanoma of


the skina and non-melanoma skin cancer (NMSC). Malignant
melanoma is the most serious type of skin cancer. NMSC
is much more common than malignant melanoma, and in
the vast majority of cases it is detected early and is not lifethreatening.

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

Malignant melanoma is a cancer that develops from


melanocytes (cells found in the deep layers of the epidermis).
Melanocytes produce the ultraviolet (UV)-protective
pigment melanin, which is responsible for the colour of skin.
NMSC most commonly develops from the epidermal cells
keratinocytes, which produce the waxy skin-strengthening
substance keratin.

Also see:

NCIN lead cancer registration


office for skin cancer - Public
Health England's Knowledge
and Intelligence team (South
West)

SunSmart, the UK's national


skin cancer prevention
campaign

INCIDENCE

Malignant melanoma is the fifth most common cancer in the


UK (2010), accounting for 4% of all new cases. In males and
females separately, malignant melanoma is the sixth most
common cancer (4% each of the male and female total).1-4
In 2010, there were 12,818 new cases of malignant melanoma
in the UK (Table 1): 6,201 (48%) in men and 6,617 (52%) in
women, giving a male: female ratio of around 10:11.1-4

Table 1: Malignant Melanoma Incidence by Country


Sex England

There are several different types of NMSC: basal cell carcinoma


(BCC) develops in keratinocytes at the bottom of the
epidermis, whilst squamous cell carcinoma (SCC) develops in
keratinocytes elsewhere in the epidermis; other cells in the skin
can also undergo malignant transformation, resulting in rarer
NMSC types such as Merkel cell carcinoma, Kaposi sarcoma,
and T-cell lymphoma of the skin.
This Cancer Statistics report summarises the most recent
statistical and epidemiological information for skin cancer
in the UK and rest of the world. The registration of NMSC is
known to be incomplete (Section 9) and so this report mainly
focuses on malignant melanoma, but information on NMSC is
presented where available.

Called malignant melanoma hereafter.

Malignant melanoma (C43)

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Wales Scotland Northern


Ireland

UK

Number of new cases1-4


Males

References

Page
1 of 20

Statistics on sunbed use

2.1 By country in the UK

3.3

3.4

INTRODUCTION

By age

Trends over
time

More on skin
cancer:
Visit cruk.org/
cancerstats for more
information on:
Skin cancer key facts

Survival from malignant melanoma has improved markedly in recent decades and is now amongst the highest for any
cancer, largely thanks to increased awareness, earlier diagnosis and better treatments. Today eight in ten malignant
melanoma patients are predicted to survive for at least ten years after their diagnosis. But there is still room for improvement,
particularly among men. Skin cancer is an extremely preventable disease. With survival rates high, the main focus of research
and practice continues to be on prevention and earlier diagnosis.

2.10 Non-

3.2

REPORT

SUMMARY

2010

524

6,201

5,151

410

116

Females

5,505

330

617

165

6,617

Persons

10,656

740

1,141

281

12,818

27.9

20.7

13.1

20.2

Crude rate per 100,0001-4

2010

Males

20.0

Females

20.8

21.5

22.9

18.0

20.9

Persons

20.4

24.6

21.8

15.6

20.6

European age-standardised rate per 100,0001-4


With 95% confidence limits

2010

Males

17.0
16.6-17.5

22.1
20.0-24.3

17.3
15.8-18.7

12.2
10.0-14.4

17.2
16.7-17.6

Females

17.3
16.8-17.7

16.7
14.9-18.5

18.4
17.0-19.9

16.1
13.6-18.5

17.3
16.9-17.7

Persons

17.0
16.7-17.3

19.2
17.8-20.6

17.7
16.6-18.7

14.0
12.3-15.6

17.1
16.8-17.4

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

SKIN
CANCER
August 2013

Incidence

The crude incidence rateb shows that there are 20 new


malignant melanoma cases for every 100,000 males in the UK,
and 21 for every 100,000 females.
The European age-standardised incidence rates (AS rates)c are
significantly higher in Wales compared with England, Scotland
and Northern Ireland (males only). They are also significantly
lower in Northern Ireland compared with Wales, England
and Scotland (males only) (Table 1).1-4 The rates do not differ
significantly between the constituent countries of the UK for
females.
The Cancer Atlas for the UK and Ireland 1991-2000, which
analysed rates at local authority and health board level,
showed that male and female malignant melanoma incidence
rates have a very similar geographical distribution. The highest
rates for both sexes occur in south west England and in the
densely populated belt of Scotland, from Glasgow in the west
to Edinburgh in the east.5
Similarly the latest analysis of malignant melanoma incidence
rates across the former cancer networks throughout the UK
reports significantly higher rates in the south and south west
regions of England, whilst the incidence rates for areas of
London are significantly lower than all other cancer networks.6,7

treatment

2.3 Trends over time


Malignant melanoma incidence rates have increased overall
in Great Britain since the mid-1970s (Figure 2).1-3 For males,
European AS incidence rates were around seven times higher
in 2008-2010 than in 1975-1977. For females, the increase is
smaller but rates have still quadrupled between 1975-1977 and
2008-2010. Since the mid-1970s in Great Britain, malignant
melanoma incidence rates have increased more rapidly than
any of the current ten most common cancers in males and
females.

Figure 2: Malignant Melanoma Incidence Over Time,

Great Britain

20
Rate per 100,000
Males
Females

2.2 By age

Persons

15

Malignant melanoma incidence is related to age, but it has an


unusual pattern when compared with most other cancer sites.
In the UK between 2008 and 2010, an average of 27% of cases
were diagnosed in those aged under 50 years, and an average
of 45% of cases were diagnosed in the 65s and over (Figure 1).1-4
This is in contrast to all cancers combined (excluding nonmelanoma skin cancer), where 11% of cases were diagnosed in
those aged under 50 during the same time period, and 63% of
cases were diagnosed in those aged 65 years and over.

10

0
1975 1980

Age-specific incidence rates increase steadily from around age


20-24 years, reaching a peak at age 85+ years for both sexes
(with the increase being sharper for males from age 55-59 years
onwards).

Figure 1: Malignant Melanoma Incidence by Age


1,000

100

800

80

600

60

400

40

5 Risk factors
6 Diagnosis and

Incidence rates are higher for females than for males in the
younger age groups, with a male:female incidence ratio of
age-specific incidence rates (to account for the different
proportions of males to females in each age group) of 4:10 in
20-24 year-olds. However, males have higher incidence rates
from age 55-59 years onwards; the male:female ratio of agespecific rates increases with age more prominently in older
age groups, from around 11:10 at age 60-64 years, to around
16:10 at age 85+ years.

1985

1990

1995

2000

2005

2010

Year of diagnosis
Malignant melanoma (C43), European age-standardised incidence rates,
Great Britain, 1975-2010.1-3

Some of the increase may be due to increased surveillance


and early detection as well as changes in diagnostic criteria,
but most is considered to be real and linked to changes in sunrelated behaviour such as an increase in frequency of holidays
abroad over time.8-11 A study published in December 2011
estimated that around 86% of malignant melanomas in the UK
in 2010 were linked to exposure to UV radiation from the sun
and sunbeds (Section 5).12

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

Rate per
20
100,000
Males
Females

Average number
200of cases per year
Males
0

Females

0 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85
to to to to to to to to to to to to to to to to to +
04 09 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84

Age at diagnosis

References

Malignant melanoma (C43), average number of new cases per


year and age-specific incidence rates, UK, 2008-2010.1-4

Page
2 of 20

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Crude rates are calculated using a simple formula in which the


number of cases is divided by the corresponding population and
multiplied by 100,000
c
Age standardisation takes account of age differences in the
underlying populations, and hence provides unbiased comparisons
of incidence rates with respect to age (for example, over time,
between sexes, or between geographical areas). Age-standardised
rates are calculated by multiplying individual age-specific rates by
corresponding proportions (or weights) in a standard population and
then summing to create an overall rate per 100,000.

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

SKIN
CANCER
August 2013

Incidence

Malignant melanoma incidence trends for the UK are shown


in Figure 3.1-4 Over the last decade (between 1999-2001 and
2008-2010) the European AS incidence rates have increased
by 65% and 46% in males and females, respectively.

Figure 3: Malignant Melanoma Incidence Over Time,

UK

20

by Age, Females

100
Rate per 100,000
15-34
35-49

50-59

60-79

80+

75

By age

Trends over
time

50

2.3

2.4

Figure 5: Malignant Melanoma Incidence Over Time

15

Lifetime risk

Distribution of
cases

25

2.5

10

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

1975 1980
-1977 -1982

5
Rate per 100,000
Males
Females

2.8

2.9

Prevalence

0
1993

1995

1985
-1987

1990
-1992

1995
-1997

2000
-2002

2005 2008
-2007 -2010

Year of diagnosis
Persons

Malignant melanoma (C43), European age-standardised incidence rates, by


age, females, Great Britain, 1975-2010.1-3

2000

2010

2005

Malignant melanoma incidence rates have increased overall for


all of the broad age groups for males in Great Britain since the
mid-1970s (Figure 4).1-4 The largest overall increase has been
for males aged 60-79 years, with European AS incidence rates
increasing around ten-fold between 1975-1977 and 2008-2010.

Malignant melanoma incidence rates in males and females


combined have also increased overall for all of the broad age
groups in Great Britain since the mid-1970s (Figure 6).1-3 As
indicated by the separate male and female rates, the largest
overall increase has been for people aged 60-79 years, with
European AS incidence rates increasing around seven-fold
between 1975-1977 and 2008-2010. Incidence rates for those
aged 50-59 years have also more than tripled over the same
time period.

Trends over
time

Figure 4: Malignant Melanoma Incidence Over Time

Figure 6: Malignant Melanoma Incidence Over Time

By stage at
diagnosis

100

Year of diagnosis

2.10 Non-

Malignant melanoma (C43), European age-standardised incidence rates, UK,


1993-2010.1-4

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

3.3

by Age, Males

3.4
3.5

In Europe

4 Mortality

by Age, Persons

100
Rate per 100,000
15-34
35-49

50-59

60-79

Rate per 100,000


15-34
35-49

80+

75

75

50

50

25

25

50-59

60-79

80+

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

1975 1980
-1977 -1982

1985
-1987

1990
-1992

1995
-1997

2000
-2002

2005 2008
-2007 -2010

1975
-1977

1980
-1982

1985
-1987

Year of diagnosis
Malignant melanoma (C43), European age-standardised incidence rates, by
age, males, Great Britain, 1975-2010.1-3

1990
-1992

1995
-1997

2000
-2002

2005 2008
-2007 -2010

Year of diagnosis
Malignant melanoma (C43), European age-standardised incidence rates, by
age, persons, Great Britain, 1975-2010.1-3

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

Malignant melanoma incidence rates have also increased


overall for all of the broad age groups for females in Great
Britain since the mid-1970s (Figure 5).1-3 Following a similar
pattern to males, the largest overall increase has also been for
females aged 60-79 years, with European AS incidence rates
increasing around five-fold between 1975-1977 and 20082010. For each of these age groups, the increase has been
faster for males than for females.

Lifetime risk is an estimation of the risk that a newborn child


has of being diagnosed with cancer at some point during their
life. It is a summary of risk in the population but genetic and
lifestyle factors affect the risk of cancer and so the risk for every
individual is different.
In 2010, in the UK, the lifetime risk of developing malignant
melanoma is 1 in 55 for men and 1 in 56 for women.13

References

Page
3 of 20

2.4 Lifetime risk

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Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

SKIN
CANCER
August 2013

The lifetime risk for malignant melanoma has been calculated


by the Statistical Information Team using the Adjusted for
Multiple Primaries (AMP) method; this accounts for the
possibility that someone can have more than one diagnosis of
malignant melanoma cancer over the course of their lifetime.14

Incidence

The majority (66%) of men and women diagnosed with


malignant melanoma present at stage I (Table 2),16 with the
proportion being higher in women (71%) than in men (61%).
Just 1% of men and women present with metastases (stage IV).

Table 2: Malignant Melanoma Cases by Stage

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Figure 7 shows the percentage distribution of malignant

melanoma on parts of the body. These vary by sex, with more


than four in ten cases in males arising on the trunk of the body,
particularly on the back, while the most common site for
females is on the legs.1-3

Figure 7: Malignant Melanoma Cases by Body Site


Head & neck

Socioeconomic
variation
Prevalence

14%
22%

Trunk

Trunk

20%
Arm

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

24%
41%

Leg

Arm

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

19%

Women

Adults

Stage I

61.4%

71.3%

66.4%

Stage II

21.0%

17.1%

19.1%

Stage III

13.7%

8.5%

11.1%

Stage IV

2.0%

0.7%

1.3%

Stage not known

1.9%

2.4%

2.1%

All stages

100.0%

100.0%

100.0%

Malignant melanoma (C43), proportion of cases diagnosed at each stage, adults


(aged 15-99), former Anglia Cancer Network, 2006-2010.16

A study using data from three English cancer registries for


2007-2009 showed that around half of malignant melanoma
cases (45% in males and 53% in females) are diagnosed when
the tumour is less than 1mm thick.17 Only 14% of males and
10% of females are diagnosed when their tumour is more than
4mm thick.17

2.7 In Europe and worldwide

Leg
13%
Not specified / 4%
overlapping

39%
Not specified / 3%
overlapping

Males

Females

Malignant melanoma (C43), percentage distribution of cases diagnosed on parts


of the body, by sex, Great Britain, 2008-2010.1-3 Percentages may not add to 100
due to rounding.

4 Mortality

By country in
the UK

Men

Head & neck

2.8

2.9

Stage at
diagnosis

2.5 Distribution of cases

Although cancer registration has a long history in many


countries of the world, particularly in the more affluent regions
such as the UK, nearly 80% of the worlds populations live in
regions that are not covered by such systems.18 Nonetheless,
with a view to characterising the global burden of the disease,
the International Agency for Research on Cancer (IARC)
routinely uses the available data to estimate worldwide cancer
incidence.19

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

2.6 By stage at diagnosis


Staging for malignant melanoma describes how deeply the
tumour has grown into the skin, and whether it has spread.
Data by stage are not yet routinely available for the UK due
to inconsistencies in the collecting and recording of staging
data in the past; this is improving, however, and plans for a
nationally consistent dataset in England are underway.15 In the
meantime, survival by stage is available for the former Anglia
Cancer Network in the east of England for the period 20062010.16
Anglia covers around 5% of the population of England and
may not be representative of the country as a whole due to
differences in underlying demographic factors (such as age,
deprivation or ethnicity), as well as variation in local healthcare
provision standards and policies. Nonetheless, the Anglia data
enable valuable comparisons between stage and malignant
melanoma to be made.

information on
skin cancer
is recorded in
the UK

References

Page
4 of 20

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Malignant melanoma is the 19th most common cancer


worldwide, estimated to be responsible for almost 200,000
new cases of cancer in 2008 (more than 1% of the total).
Malignant melanoma incidence rates are highest in Australia/
New Zealand and lowest in South-Central Asia, with around
a 200-fold variation in World AS incidence rates between the
regions of the world for males, and around a 160-fold variation
for females (Figure 8, see next page).19
The majority of malignant melanomas are caused by heavy
sun exposure in white-skinned populations.20,21 Incidence rates
are highest by far in Australia/New Zealand, where it is the third
most common cancer in both males and females, accounting
for one in nine (around 11% in 2008) of the total cases.19
Incidence rates are increasing rapidly in many countries,
including in the Nordic countries, where the increase has been
attributed to excessive sun exposure during holidays at lower
latitudes.20

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Contents

SKIN
CANCER
August 2013

2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Incidence

Figure 8: Malignant Melanoma Incidence Worldwide


0

1 Introduction

10

20

30

40

Figure 9: Malignant Melanoma Incidence in Europe

50

Australia/
New Zealand
Northern
America
Northern
Europe
Western
Europe
Southern
Europe
Southern
Africa
Central and
Eastern Europe

10

15

20

25

30

Sweden
The Netherlands
Slovenia
Czech Republic
Ireland
UK
Germany

World

Finland

South
America

Luxembourg
Belgium

Eastern Africa

Slovakia

Middle Africa

EU-27

Central
America

Italy

Western Asia

Hungary
France
(Metropolitan)
Austria

Western Africa
Caribbean
South
-Eastern Asia
Northern
Africa

Denmark

Estonia
Rate per 100,000
Males

Females

Eastern Asia
South
-Central Asia
Malignant melanoma (C43), World age-standardised incidence rates, world
regions, 2008 estimates.19

Within the 27 countries of the European Union (EU-27), the


highest malignant melanoma European AS incidence rates
are estimated to be in Sweden for males (around 22 cases
per 100,000) and Denmark for females (around 26 cases per
100,000), and the lowest rates are estimated to be in Greece
for both sexes (more than 3 male cases per 100,000, and
around 3 female cases per 100,000) (Figure 9).22

Malta
Spain
Lithuania
Latvia
Portugal
Poland
Bulgaria
Cyprus

Rate per 100,000


Males

Females

Romania
Greece
Malignant melanoma (C43), European age-standardised incidence rates, EU-27
countries, 2008 estimates.22

UK malignant melanoma incidence rates are estimated


to be the seventh and sixth highest in males and females,
respectively, in Europe (EU-27).22

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
5 of 20

2.8 Socio-economic variation


Malignant melanoma incidence is strongly inversely related
to deprivation in the UK; it is one of the few cancers where
incidence rates are lower for more deprived men and women
and there is a clear trend of decreasing rates from the least to
the most deprived.23-26 The most recent England-wide data
for 2000-2004 show European AS incidence rates are 122%
higher for men living in the least deprived areas compared with
the most deprived, and 116% higher for women.23
It has been estimated that there would have been an additional
2,000 new malignant melanoma cancer cases each year
in England during 2000-2004 if all men and women had
experienced the same incidence rates as the most affluent.23

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

A study in Scotland for 2006-2010 showed that the gap in


malignant melanoma incidence by deprivation is slightly
smaller, with the least deprived people having 81% higher rates,
compared with the most deprived.24 Comparable associations
with deprivation have also been reported in Wales and
Northern Ireland.25,26

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

SKIN
CANCER
August 2013
Prevalence refers to the number of people who have
previously received a diagnosis of cancer and who are still
alive at a given time point. Some patients will have been cured
of their disease and others will not. The latest estimates for
the UK (Table 3) show that nearly 60,000 men and women
were still alive at the end of 2006, up to ten years after being
diagnosed with malignant melanoma.27 Worldwide, it is
estimated that there were around 756,000 cancer patients still
alive in 2008, up to five years after their diagnosis.19

Table 3: Malignant Melanoma Prevalence


One-year

Five-year

Ten-year

Males

4,278

16,118

24,617

Females

5,132

21,203

34,530

Persons

9,410

37,321

59,147

Malignant melanoma (C43), one-, five- and ten-year cancer prevalence, UK, 31st
December 2006.27

2.10 Non-melanoma skin cancer


Non-melanoma skin cancers (NMSC) are extremely common,
but relatively few deaths (see Section 4.5) are caused by them.
In 2010, there were 99,549 cases of NMSC registered in the
UK: 56% in men and 44% in women, giving a male:female ratio
of 13:10.1-4
The majority of NMSCs are BCCs (74%) or SCCs (23%).28 The
remainder comprises a mixed group of rare skin cancers;
almost three in ten of these are Merkel cell carcinoma, which
has a very poor prognosis.29
Both BCC and SCC are more common in males than females,
though the sex difference is wider for SCC than BCC.28 The
recorded incidence of BCC increased by around a third
(36% in males and 32% in females) between 2000-2002
and 2008-2010 in England, Scotland, Northern Ireland and
Ireland combined.28 SCC incidence increased by a similar
amount (34% in males and 39% in females) over the same time
period.28 Whilst improved registration may partly explain these
increases, some of the increase is probably genuine, reflecting
increased UV exposure from the sun or sunbeds.28


3.1 One-, five- and ten-year survival
Age-standardised relative survivald for malignant melanoma
in England during 2005-2009 shows that 96% of men survive
their disease for at least one year, falling to 84% surviving for
five years or more (Table 4).36,37 Survival for women is slightly
higher, with 98% surviving for one year or more, and 92%
surviving for at least five years. Broadly similar survival has been
reported for Wales, Scotland and Northern Ireland.38-40
Survival continues to fall slightly beyond five years after
diagnosis, with 80% of men and 90% of women predicted to
survive for at least ten years (Table 4).37
Five-year survival for malignant melanoma is amongst the
highest of the 21 most common cancers in England.36
However, with an absolute survival differencee of 8%, malignant
melanoma shows one of the largest disparities in five-year
survival between the sexes. Differences in the thickness of
tumours between men and women may explain some of
the variation, as well as diverse attitudes to health-related
behaviour.41,42

Table 4: Malignant Melanoma One-, Five- and Ten-

Year Survival

Sex

One-year

Five-year

2005-2009

2005-2009

Ten-year
2009

Men

95.7%

83.6%

79.7%

Women

97.7%

91.6%

90.1%

Malignant melanoma (C43), one-, five- and ten-year age-standardised relative


survival, adults aged 15-99, England, 2005-2009.36 Ten-year survival has been
predicted for patients diagnosed in 2009 (using the hybrid approach).37

Like with most cancers, treatment for malignant melanoma is


much more effective when the disease is caught at an early
stage (see Section 3.4).
Survival data for NMSC is not routinely available, and is
therefore not shown. However, in the majority of cases, NMSC
is detected early and is not life threatening.

NMSCs constitute a substantial burden to the national health


services across the UK because of the large number of cases
diagnosed each year, however NMSC incidence figures are
under-estimates because the recording of NMSC is known to
be incomplete.27 Many cancer registries record only the first
NMSC of each histological type (e.g. BCC or SCC) per person,
and information on small NMSCs treated in primary care or the
private sector may never reach the registries.29 An estimated
30-50% of BCC and around 30% of SCC goes unrecorded,
though this may vary by registry.30-33
Both BCC and SCC are highly treatable and survival rates
for NMSCs are very high.34 However, if left untreated, these
tumours can become destructive, invading local tissues and
causing disfigurement.35

References

Page
6 of 20

SURVIVAL

2.9 Prevalence

Sex

Incidence to
Survival

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Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Relative survival takes into account the fact that the person may have
died even if they did not have cancer; it is relative to the rest of the
population.

An absolute change in survival is the numerical difference when one


survival rate is taken away from another.

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

SKIN
CANCER
August 2013
3.2 By age

As with nearly all cancers, survival for malignant melanoma is


higher in younger men and women, even after taking account
of the higher background mortality in older people. The
reasons for this are likely to include a combination of better
general health, more effective response to treatment and
earlier diagnosis in younger people overall.

Age

By age

Trends over
time

Males

25%

50%

75%

By stage at
diagnosis

3.5

50%

75%

100%

1971-1975

40-49
50-59
60-69
70-79

1981-1985
1986-1990
1991-1995
1996-2000

80-99

2001-2005
Malignant melanoma (C43), five-year relative survival by age at diagnosis, adults
aged 15-99, England, 2005-2009.36

2005-2009

In Europe

4 Mortality

By country in
the UK

4.1

4.2

25%

One-year survival
Five-year survival
Ten-year survival

100%

3.3

3.4

0%

Females

Females

15-39
Age at diagnosis

One-, fiveand ten-year


survival

3.2

0%

Prevalence

3.1

Year Survival Over Time

1976-1980

Socioeconomic
variation

3 Survival

Figure 11: Malignant Melanoma One-, Five- and Ten-

Figure 10: Malignant Melanoma Five-Year Survival by

2.8

melanoma skin
cancer

Ten-year age-standardised relative survival for men diagnosed


with malignant melanoma in England increased from 39%
during 1971-1975 to a predicted 80% in 2009 (Table 4 and
Figure 11).36,37 In women, ten-year survival increased from 58%
to a predicted 90% over the same time periods, respectively.

Males

In Europe and
worldwide

2.10 Non-

Survival

In men, five-year relative survival for malignant melanoma in


England during 2005-2009 ranges from 90% in 15-39 yearolds to 64% in 80-99 year-olds (Figure 10).36 Five-year survival
is higher in women than men across all age groups, ranging
from 96% in 15-39 year-olds to 85% in 80-99 year-olds.

2.7

2.9

Year of diagnosis

Cancer
Cancer
Statistics
Statistics

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
7 of 20

3.3 Trends over time


As with the majority of cancers, survival for malignant
melanoma is improving. This can generally be attributed to
faster diagnosis and improvements in treatment. However,
there is still scope for improvement and increasing cancer
survival remains a major priority of Improving Outcomes: A
Strategy for Cancer.43
One-year survival can be used as an indicator of early
diagnosis, since death before one year is likely to be due to
the disease being diagnosed at a late stage. In men, one-year
age-standardised relative survival for malignant melanoma
in England increased from 79% during 1971-1975 to 96%
during 2005-2009 (Figure 11).36,37 In women, one-year survival
increased from 89% to 98% over the same time periods,
respectively. Part of the increase in both sexes will be due
to increased awareness and earlier diagnosis of the disease
as a result of public heath campaigns such as SunSmart
(See Section 7); concomitantly, several studies have reported
increasing proportions of thin, early stage tumours in recent
years.41,44,45
Whilst survival is still influenced by early diagnosis after
five years, it is also strongly dependent on the success of
treatment. In men, five-year age-standardised relative survival
for malignant melanoma in England increased from 47%
during 1971-1975 to 84% during 2005-2009 (Figure 11).36,37 In
women, five-year survival increased from 65% to 92% over the
same time periods, respectively.

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Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Malignant melanoma (C43), age-standardised one-, five- and ten-year relative


survival, adults aged 15-99, England, 1971-2009.36,37

3.4 By stage at diagnosis


Survival by stage is not yet routinely available for the UK due
to inconsistencies in the collecting and recording of staging
data in the past; this is improving, however, and plans for a
nationally consistent dataset in England are underway.43 In the
meantime, survival by stage is available for the former Anglia
Cancer Network in the east of England for the period 20062010.46 Anglia covers around 5% of the population of England
and may not be representative of the country as a whole due
to differences in underlying demographic factors (such as age,
deprivation or ethnicity), as well as variation in local healthcare
provision standards and policies. Nonetheless, the Anglia data
enable valuable comparisons between stage and cancer to be
made.
Survival for malignant melanoma is strongly related to stage
of the disease at diagnosis.46 The majority (66%) of patients
present at stage I (see Section 2.6). Just 1% of patients present
with metastases (stage IV).

Cancer
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Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

SKIN
CANCER
August 2013
One-year relative survival is highest for patients presenting at
stage I, with 101%f of men and women surviving for at least
one year (Figure 12).46 In comparison, one-year survival is
considerably lower for those diagnosed with stage IV disease
(10% for men and 35% for women). As very few patients
are diagnosed at Stage IV, however, the one-year survival
statistics have wide confidence intervals and should therefore
be interpreted with caution. There are no significant sex
differences at any of the stages.

Figure 12: Malignant Melanoma One-Year Survival by

Stage

Lifetime risk

Distribution of
cases

Males

Females

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

0%

20%

40%

60%

80%

100%

Stage I

2.7

Socioeconomic
variation

Stage II

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

Stage III
Stage IV
Stage
not known
All stages

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

Malignant melanoma (C43), one-year relative survival by stage, adults aged 1599, former Anglia Cancer Network, 2006-2010.46

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

Figure 13: Malignant Melanoma Five-Year Survival by

Stage

0%

Males

20%

40%

60%

80%

Females

100%

Stage I

treatment

7 The future

Stage II

8 Acknowledge-

Stage III

9 How

Stage IV

ments

information on
skin cancer
is recorded in
the UK

References

Stage
not known
All stages
Malignant melanoma (C43), five-year relative survival by stage, adults aged 1599, former Anglia Cancer Network, 2002-2006.46

Page
8 of 20

3.5 In Europe
EUROCARE (European Cancer Registry-based study on survival
and care of cancer patients) is a series of cancer registry-based
comparisons of cancer survival by country in Europe.47 Whilst
the studies have some unavoidable limitations and the survival
statistics should be viewed with some caution,48-51 EUROCARE
is the largest co-ordinated effort at providing comparative
survival statistics across Europe.
The most recent study in the series, EUROCARE-4, used data
collected from 82 cancer registries in 23 European countries
for the analysis of 2.7 million adult cancer patients diagnosed
in the period 1995-1999.52,53
Malignant melanoma is one of the few cancers in which fiveyear relative survival in England is significantly higher than the
European average. The study showed there is considerable
variation within the UK, however, with significantly lower fiveyear survival in Wales (74%) compared with England, Scotland
and Northern Ireland (85%, 89% and 93%, respectively).52,53
Such comparatively low survival in Wales may be explained by
differences in stage at diagnosis, particularly among the more
deprived men and women who seem to fare worse compared
with their UK counterparts.54 Differences in public awareness
and early diagnosis initiatives may also play a role. It has been
estimated that around 930 deaths could be avoided within five
years of diagnosis if malignant melanoma survival in Britain
equalled the best in Europe.55
f

Five-year survival for malignant melanoma is similarly strongly


related to the stage of the disease at diagnosis, but there is
a much more gradual decrease in survival between stages I
and IV. Five-year relative survival ranges from 102%f (for men)
and 100% (for women) at Stage I to 8% (for men) and 25% (for
women) at Stage IV (Figure 13).46 As expected, five-year survival
is significantly lower than one-year survival across most
known-stage groups within each sex. The exceptions are men
and women presenting at Stage I, whose five-year survival
remains at 100%, and men and women presenting at Stage IV,
in whom survival does not differ significantly between one and
five years (though, as before, low patient numbers preclude
reliable analysis).

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Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Survival to
Mortality

Relative survival can be greater than 100% because it accounts for


background mortality. A relative survival figure greater than 100
indicates that people diagnosed have a better chance of surviving one
or five years after diagnosis than the general population.

MORTALITY


4.1 By country in the UK
Malignant melanoma is the 18th most common cause of
cancer death in the UK (2011), accounting for 1% of all
deaths from cancer. Malignant melanoma is the 17th most
common cause of cancer death among men in the UK (2011),
accounting for 2% of all male deaths from cancer. Among
women in the UK, malignant melanoma is the 18th most
common cause of cancer death (2011), accounting for 1% of all
female cancer deaths.56-58
In 2011, there were 2,209 deaths from malignant melanoma
in the UK (Table 5, see next page): 1,295 (59%) in men and
914 (41%) in women, giving a male:female ratio of 14:10.56-58
The crude mortality rateb shows that there are 4 malignant
melanoma deaths for every 100,000 males in the UK, and 3 for
every 100,000 females.
The European age-standardised mortality rates (AS rates)c do
not differ significantly between the constituent countries of
the UK (Table 5).56-58 The latest analysis of malignant melanoma
mortality rates throughout the UK reports only modest
variation between the former cancer networks.6,7

Cancer
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REPORT
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SKIN
CANCER
August 2013

Mortality

Table 5: Malignant Melanoma Mortality by Country

Contents
Sex

England

1 Introduction

Wales Scotland Northern


Ireland

UK

Number of deaths

56-58

2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

1,088

75

105

27

1,295

Females

783

43

71

17

914

Persons

1,871

118

176

44

2,209

Crude rate per 100,00056-58

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

2011

Males

4.2

5.0

4.1

3.0

4.2

Females

2.9

2.8

2.6

1.8

2.8

Persons

3.5

3.9

3.3

2.4

3.5

European age-standardised rate per 100,00056-58


With 95% confidence limits

2011

Males

3.3
3.1-3.5

3.9
3.0-4.8

3.3
2.7-3.9

2.8
1.8-3.9

3.4
3.2-3.5

Females

2.0
1.9-2.1

2.0
1.4-2.6

1.8
1.3-2.2

1.3
0.7-1.9

2.0
1.8-2.1

Persons

2.6
2.5-2.7

2.9
2.4-3.4

2.4
2.1-2.8

2.0
1.4-2.6

2.6
2.5-2.7

Prevalence

2.10 Non-

2011

Males

treatment

Malignant melanoma mortality rates have increased overall


in the UK since the early 1970s (Figure 15).56-58 For males,
European AS mortality rates increased by 185% between 19711973 and 2009-2011. The rise is smaller for women, with rates
increasing by 55% between 1971-1973 and 2009-2011. From
the late 1980s onwards, mortality rates have increased much
more quickly in males than in females, causing a divergence
of the rates between the sexes. This is in contrast to malignant
melanoma incidence rates in males and females, which
have converged in the last decades (see Section 2.3).Over
the last decade (between 2000-2002 and 2009-2011), the
European AS mortality rates have increased by 22% in males
and remained stable in females. The increase in malignant
melanoma mortality rates is likely to be a reflection of the
increase in incidence rates. The increase in mortality rates is
much less pronounced, however, due to improvements in
survival (as a result of earlier diagnosis and better treatment).
The lower mortality rates in females since the mid-1980s
mirror the better survival rates seen in women (see Section 3).

Figure 15: Malignant Melanoma Mortality Over Time


Malignant melanoma (C43)

4.2 By age

Malignant melanoma mortality is strongly related to age, with


the highest mortality rates being in older men and women. In
the UK between 2009 and 2011, an average of 5% of malignant
melanoma deaths were in the 15-39 age group, whilst an
average of 38% of deaths were in people aged 75 years and
over (Figure 14).56-58
Age-specific mortality rates increase sharply from around age
50-54 years in both men and women, reaching a peak at age
85 and over in both sexes. Mortality rates are generally similar
between males and females until age 50-54 onwards, when
rates are higher for males than for females. This is in contrast
to incidence rates which are higher for females until the mid50s. The widest gap between the ages is for those aged 70-74
years, when the male:female mortality ratio of age-specific
rates (to account for the different proportions of males to
females in each age group) is 20:10.

Figure 14: Malignant Melanoma Mortality by Age


200

40

150

30

100

20

5 Risk factors
6 Diagnosis and

4.3 Trends over time

1
Rate per 100,000
Males
Females
0

1971 1975

1980

1985

Persons

1990

1995

2000

2005

2011

Year of death
Malignant melanoma (C43), European age-standardised mortality rates, UK,
1971-2011.56-58

Malignant melanoma mortality rates have increased overall for


most of the broad age groups in the UK since the early 1970s,
except those aged 15-39 and 40-49 years (Figure 16, see next
page).56-58 The largest increases have been in people aged 75
years and over, with European AS mortality rates more than
quadrupling between 1971-1973 and 2009-2011.

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

50

Rate per
100,000
Males
Females

Average number
of deaths per year

Males
0

Females

0 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85
to to to to to to to to to to to to to to to to to +
04 09 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84

10

Age at death

Page
9 of 20

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Malignant melanoma (C43), average number of deaths per year and age-specific
mortality rates, UK, 2009-2011.56-58

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1 Introduction
2 Incidence

By country in
the UK

2.1

SKIN
CANCER
August 2013

Mortality

Figure 16: Malignant Melanoma Mortality Over Time

by Age

20
Rate per 100,000
15-39
40-49

50-64

65-74

Worldwide cancer mortality data are collated and distributed


by the World Health Organisation.60 As with the collation of
incidence data, there is wide variation in the coverage of death
registration systems across the world, with two-thirds of the
worlds populations living in regions that are not covered by
mortality statistics, as well as variation in the quality of the cause
of death information itself.18 IARC routinely uses the available
data to estimate worldwide cancer mortality.19

75+

15

By age

2.2

Trends over
time

2.3

10

Lifetime risk

2.4

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

Prevalence

2.9

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

By age

3.2

Trends over
time

3.3

By stage at
diagnosis

3.4

In Europe

3.5

4 Mortality

By country in
the UK

4.1

By age

4.2

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
10 of 20

0
1971 1975
-1973 -1977

1980
-1982

1985
-1987

1990
-1992

1995
-1997

2000
-2002

2005 2009
-2007 -2011

Year of death
Malignant melanoma (C43), European age-standardised mortality rates, by age,
persons, UK, 1971-2011.56-58

The increase in mortality rates over time in the older age


groups may be explained in part by late diagnosis, and figures
have recently shown that people aged 65 and over are more
likely to be diagnosed with malignant melanoma at a late stage
compared with younger people.59

Figure 17: Malignant Melanoma Mortality Worldwide


0

4.4 In Europe and worldwide

Malignant melanoma is the 23rd most common cause of


cancer death worldwide, estimated to be responsible for
more than 46,000 deaths in 2008 (around 0.6% of the total).
Malignant melanoma mortality rates are highest in Australia and
New Zealand and lowest in South Central Asia, with a 49-fold
variation in World AS mortality rates between the regions of the
world for males, and a 23-fold variation for females (Figure 17).19

Figure 18: Malignant Melanoma Mortality in Europe


0

Denmark
Slovakia
Slovenia

Australia
/New Zealand
Southern
Africa
Northern
Europe
Northern
America
Western
Europe
Central and
Eastern Europe
Southern
Europe
Eastern
Africa
Middle
Africa
South America

Germany

Ireland
Austria
Hungary
Luxembourg
Czech Republic
Finland
Poland
UK
Latvia
EU-27

World

Malta

Central
America

Lithuania
Italy
France
(Metropolitan)
Belgium

Western Africa
Western Asia
Caribbean

Bulgaria

South
-Eastern Asia

Northern Africa

Estonia

The Netherlands

Eastern Asia

Sweden

Spain
Rate per 100,000
Males

Females

South
-Central Asia

Malignant melanoma (C43), World age-standardised mortality rates, World


regions, 2008 estimates.19

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Portugal
Romania

Rate per 100,000


Males

Females

Greece
Cyprus
Malignant melanoma (C43), European age-standardised mortality rates, EU-27
countries, 2008 estimates.22

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REPORT
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Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Distribution of
cases
By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

Within the 27 countries of the European Union (EU-27), the


highest malignant melanoma European AS mortality rates are
estimated to be in Sweden for both males (around 5 deaths
per 100,000) and females (around 3 deaths per 100,000), and
the lowest rates are estimated to be in Cyprus for males (1
male death per 100,000), and Greece for females (around 1
female death per 100,000) (Figure 18, see previous page).22
UK malignant melanoma mortality rates are estimated to be
the 14th (males) and 13th (females) highest in Europe (EU-27).

Mortality to
Risk factors

4.5 Non-melanoma skin cancer


NMSC is an extremely common cancer (see Section 2.10), but
relatively few deaths are caused by it. In 2011, there were 585
deaths from NMSC in the UK; of which 62% were in males.56-58
BCCs rarely metastasise (spread) and are unlikely to be fatal,
though they can cause disfigurement;35 in contrast SCCs
sometimes spread and can therefore lead to death.61

Lifetime risk

2.5

2.9

SKIN
CANCER
August 2013

By age

Trends over
time

RISK FACTORS

The main risk factor for malignant melanoma and NMSC are UV radiation (from sun exposure and sunbeds). Skin type and hair
and eye colour, sunscreen use, family history, previous cancer, and other medical conditions also impact on skin cancer risk.
In the sections which follow, meta-analyses and systematic reviews are cited where available, as they provide the best overview
of all available research and often take study quality into account. Individual case-control and cohort studies are reported where
good quality aggregated data are lacking.

5.1 Ultraviolet radiation from sun


exposure
Excess exposure to UV radiation is the main preventable risk
factor for skin cancer. 62,63 The sun is the principal source
of natural UV radiation, whilst sunbeds produce artificial UV
radiation.
UVA and UVB are the two types of solar radiation which
reach us on Earth. Both types are linked to skin cancer. UVB is
predominantly responsible for burning, whilst UVA penetrates
deeper into the skin and is linked with premature ageing.
It is also expected that climate change will cause more skin
cancer cases in the future, as more UV radiation reaches us on
Earth, and warmer temperatures encourage people to spend
more time in direct sunlight.64

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

There is sufficient evidence that too much exposure to solar


UV radiation is the main cause of both malignant melanoma
and NMSC, according to IARC.65,66 It is estimated that around
11,100 (86%) malignant melanoma cases in the UK in 2010
were linked to UV radiation exposure.62 Among NMSCs, an
estimated 50-70% of SCCs and 50-90% of BCCs in fair-skinned
people are caused by UV radiation.67

5.1.1 Intermittent sun exposure and


sunburn
Risk of malignant melanoma is most strongly linked to
intermittent exposure to high-intensity sunlight (for example
from sunbathing, doing watersports or holidaying in a place
where the sun is strong), a meta-analysis has shown.68
Intermittent sun exposure was associated with a 60% increased
risk of malignant melanoma, though this effect was smaller
and not significant in studies of UK, US, Canadian or Australian
populations.68

References

Page
11 of 20

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Scotland (SC041666) and the Isle of Man (1103)

Intermittent exposure to high-intensity sunlight often results


in sunburn,68 and a history of sunburn doubles the risk of
malignant melanoma.68,69 Having had 26 or more episodes
of painful or severe sunburn during your lifetime increases
the risk of malignant melanoma by two to three times in
women, a pooled analysis showed.70 Malignant melanoma
risk is increased regardless of whether sunburn occurred in
childhood or adulthood.68,71
Sunburn, especially in childhood, or intermittent exposure
to sunlight, also increases the risk of BCC.72,73 Sunburn and
intermittent sunlight exposure is believed to have less of an
effect on SCC risk.74-76
Exposure to UV radiation has increased in recent decades
in the UK population, as people have increasingly sought a
suntan by holidaying abroad.

5.1.2 Chronic sun exposure


Chronic or more continuous sunlight exposure, for example
that received by people with outdoor occupations, did not
appear to increase malignant melanoma risk in a recent
meta-analysis, though the review authors commented that
occupational sun exposure still probably increases risk over no
sun exposure at all.68
There is evidence that chronic sun exposure increases the risk
of NMSC. People who work outdoors are at 43% higher risk
of BCC,77 and 77% higher risk of SCC,78 and these effects are
stronger in countries nearer the equator, two meta-analyses
have found.77,78

Cancer
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Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

SKIN
CANCER
August 2013

5.2 Ultraviolet radiation from sunbeds


There is sufficient evidence that use of sunbeds causes
malignant melanoma, IARC states.66 IARC also states there
is limited evidence that sunbed use causes SCC.66 There is
currently no IARC statement on sunbeds and BCC.

Table 6: People Who Should Not Use Sunbeds


People who have skin phototypes I or II (See Table 7 for definition)
Children (i.e. less than 18 years of age)
People who have large numbers of naevi (moles)

Use of a sunbed for the first time before age 35 increases


the risk of malignant melanoma by 59%, and use at any age
increases malignant melanoma risk by 20-25%, the most
recent meta-analysis showed.79,80 Women using a sunbed
once a month or more in their 30s increase their malignant
melanoma risk by 49%, and those doing so in their 40s face
a 61% increased risk, one large study included in that analysis
showed.81 Another cohort study showed women aged 25-39
who use a sunbed more than 10 times a year have two-anda-half times the malignant melanoma risk compared with
women who do not use sunbeds.82 Sunbed use is estimated
to cause around one hundred deaths a year from malignant
melanoma in the UK.79,83
Sunbed use at any age increases the risk of SCC by 67%, and
increases BCC risk by 29%, according to the most recent
meta-analysis.84 Risk increases for both types of NMSC in
relation to sunbed use were also shown in an earlier metaanalysis.79 Exposure before age 25 appears to confer even
greater risk increases, though in meta-analysis the effect was
significant only for BCC (40% risk increase).84 Women who
used a sunbed more than six times a year during high school
increased their BCC risk by 73% in comparison with those who
didnt use a sunbed, a US cohort study showed.85 And both
SCC and BCC risk were increased by 15% for every four sunbed
sessions a year during high school or at age 25-35.85 Using a
sunbed without ever burning appears to be no safer it can
increase the risk of malignant melanoma and early-onset BCC
(diagnosed in people under 40 years old) by more than 60%,
recent case-control studies have shown. 86,87

5.2.1 Prevalence of sunbed use


In 1999 a quarter of men and a third of women in Britain
reported trying to get a tan in the previous six months. There
were even higher rates amongst younger people. Overall, 2%
of adults trying to get a tan did so using a sunbed or tanning
machine only.88 In 2008 and 2009, 6% of 11-17-year-olds
in England reported they had used a sunbed,89 and in 2008,
5% of under-25s in Northern Ireland reported currently using
sunbeds.90
Use of sunbeds by under-18s is now banned across the
UK, with legislation passed in 2008 in Scotland, and 2011 in
England, Wales and Northern Ireland.
The possibility that younger people and those with highrisk skin types are at greatest risk of skin cancer due to
sunbed use is widely recognised. In 2003 the International
Commission on Non-Ionizing Radiation Protection (ICNIRP)
and the World Health Organisation (WHO) recommended that
certain categories of people should not use sunbeds (Table
6).91,92 ICNIRP also concluded that anyone using suntanning
appliances is likely to raise their risk of skin cancer, eye
damage, photodermatosis, photosensitivity and premature skin
ageing.91
Cancer Research UK recommends that people do not use
sunbeds.

Page
12 of 20

Risk factors

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People who tend to freckle


People who have a history of frequent childhood sunburn
People who have pre-malignant or malignant skin lesions
People who have sun-damaged skin
People who are wearing cosmetics these may enhance their sensitivity to UV exposure
People taking medications which make them UV-sensitive.

Categories of people who should not use sunbeds, as recommended by ICNIRP


and WHO.

5.3 Skin type, hair and eye colour


People with light eyes, skin or hair, or with skin that sunburns
easily or does not tan, have an increased risk of skin
cancer.72,75,93,94 These factors in combination are used to
define the skin phototype (Table 7). This classification is used
in most studies exploring pigmentary characteristics and skin
cancer risk.93

Table 7: Skin Phototypes


Phototype

Typical Features

Tanning Ability

Type I

Tends to have freckles, red or fair


hair, and blue or green eyes.

Often burns, rarely


tans.

Type II

Tends to have light hair, and blue


or brown eyes.

Usually burns,
sometimes tans.

Type III

Tends to have brown hair and


eyes.

Sometimes burns,
usually tans.

Type IV

Tends to have dark brown eyes


and hair.

Rarely burns, often


tans.

Type V

Naturally black-brown skin. Often


has dark brown eyes and hair.

Type VI

Naturally black-brown skin. Usually


has black-brown eyes and hair.

Based on: Fitzpatrick T. Soleil et peau. J Med Esthet 1975;2:33-4.

In comparison with people with skin phototype IV, those with


skin phototype I are at more than double (2.27 times) the
malignant melanoma risk, phototype II at double (1.99 times)
the risk, and phototype III at 35% increased risk, a recent metaanalysis reported.93
In comparison with dark-eyed people, those with blue/bluegrey eyes have a 57% higher malignant melanoma risk, and
those with green/grey/hazel eyes have a 51% increased risk.93

Cancer
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Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

SKIN
CANCER
August 2013

In comparison with dark-haired people, those with red/redblonde hair were shown to be at up to triple the malignant
melanoma risk.93,95 Blondes are at double the risk, and people
with light brown hair are at 46% increased risk.93
People with freckles were found to have around double (1.99
times) the risk of malignant melanoma, versus people without
freckles.93 People with freckles have increased malignant
melanoma risk, regardless of the number of moles they have.96
People with blue/green-blue/green-grey eyes are at increased
risk of BCC.97 People with red and light-coloured hair are at
increased risk of BCC and SCC.98-100

5.4 Moles (naevi)


Meta-analyses show people with any unusually shaped or
large moles (also called atypical naevi; these are usually larger
than common naevi, with a more variegated appearance,
poorly-defined border, and some areas slightly raised)
have around four to ten times increased risk of malignant
melanoma,101,102 and the risk increases with the number of
atypical moles.101 People with very high numbers (100+) of
common moles on their bodies have nearly seven times the
risk compared to people with very few (0-15 moles),101 and
every additional common mole increases the risk of malignant
melanoma by around 2%.102
People with dysplastic mole syndrome (also known as Familial
Atypical Multiple Mole-Melanoma Syndrome or FAMMM;
characterised by multiple atypical moles that continue
to appear in adulthood) and a family history of malignant
melanoma have a 500-fold increased risk of developing
malignant melanoma;103 however this is very rare and
accounts for less than 5% of malignant melanoma cases.101
Most moles are genetically determined (inherited), though
sun exposure can increase the number of moles. Most moles
appear during childhood.96,104 The emergence of moles in
adolescents is under strong genetic control, a UK study of
moles in twins concluded.105 Chronic sun exposure rather
than number of sunburn episodes is the most important
environmental factor determining mole development.96

5.5 Sunscreen use

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
13 of 20

The impact of sunscreen use on skin cancer risk remains


unclear, due largely to methodological limitations.106,107
Sunscreen should be used together with clothing and shade to
protect the skin from sun damage, and should never be used
to spend longer in the sun.
Research shows sunscreen users may counteract the
protective effect of sunscreens by: spending longer in the sun
than non-users; applying their sunscreen incorrectly; or failing
to use protective clothing.108-111

5.6 Vitamin D
The only established benefit of exposure to solar UV radiation
is the synthesis of vitamin D, which is vital for bone health.
Higher circulating levels of vitamin D in the blood are
associated with lower risk of bowel cancer, although it is
unclear whether this is a causal relationship.112-116

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Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Risk factors

However, sunbathing, tanning or burning should not be


necessary to make sufficient vitamin D to obtain health
benefits. In fair-skinned people, the time taken to make
enough vitamin D is short, and less than the time taken for
skin to redden or burn.117 Once sufficient vitamin D is made,
any extra is turned into inactive substances.118 So more sun
exposure does not equate to greater health benefits, and
excessive exposure to solar UV radiation is not a means of
reducing the incidence or mortality of cancer.

5.7 Family history


People with a family history of malignant melanoma have
roughly double the risk of developing the disease, compared
to people without a family history.119,120 A small percentage of
malignant melanoma cases (around 10%) are attributable to
inherited risk.121,122
FAMMM is one of several rare hereditary syndromes associated
with an increased risk of malignant melanoma.123 FAMMM is
associated with the hereditary susceptibility genes CDKN2A
and CDK4. CDKN2A mutation carriers often have three or
more family members with malignant melanoma, or have
multiple primary malignant melanomas with no family history.
CDKN2A mutation carriers living in Europe have a 58% risk
of developing malignant melanoma by age 80.124 Malignant
melanoma and NMSC have been linked to Li Fraumeni
syndrome in some studies, although they are not among the
core cancers occurring in Li Fraumeni families.125 People
with a family history of SCC have an increased risk of SCC.126
People with a family history of malignant melanoma have an
increased risk of BCC.127

5.8 Previous cancer


Previous malignant melanoma is associated with eight- to
twelve-fold increased risk of a second malignant melanoma.
128-130
The effect is stronger for women.128,129 People with a
previous malignant melanoma and a parent with malignant
melanoma are at more than 30-fold risk of a second
malignant melanoma.131 Malignant melanoma risk is higher
among people with a previous diagnosis of various other
cancers, including female breast cancer,132,133 non-Hodgkin
lymphoma,134,135 renal cell carcinoma,134 certain childhood
cancers,136,137 prostate cancer,132,138 thyroid cancer,132 and
leukaemia.132 Generally the increase in risk was less than
double. Often these associations are bi-directional,128
supporting shared genetic or environmental factors.
Previous SCC is associated with ten times higher risk of a
second BCC or SCC, whilst previous BCC is associated with
ten times higher risk of second BCC but a lower increase
in second SCC risk.139-141 Previous malignant melanoma is
associated with three-fold increased risk of NMSC.142 People
who have had NMSC are also at increased risk of other second
primary cancers.143

5.9 Other medical conditions,


treatments and procedures
Organ transplant recipients are at 29-fold increased NMSC risk,
and two-fold increased malignant melanoma risk, a metaanalysis shows.144-146

Cancer
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Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

By age

2.2

Trends over
time

2.3

Lifetime risk

2.4

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

Prevalence

2.9

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

By age

3.2

Trends over
time

3.3

By stage at
diagnosis

3.4

In Europe

3.5

4 Mortality

By country in
the UK

4.1

By age

4.2

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

SKIN
CANCER
August 2013

This may be related to the use of immunosuppressant drugs


called azathioprine and cyclosporine, which IARC states are
causes of NMSC.66
People with Crohn's disease have an 80% increased risk of
malignant melanoma, and people with ulcerative colitis have
a 23% increased risk, a meta-analysis shows.147 Treatment for
these bowel conditions may include immunosuppressant
drugs, but the increase in malignant melanoma risk appears to
be independent of treatment.147
People with atopic dermatitis (the most common form of
eczema) appear to have an increased risk of NMSC, but
the association between atopic dermatitis and malignant
melanoma remains unclear.148,149 Contact allergy may reduce
the risk of NMSC very slightly.150 A drug called methoxsalen
is used in conjunction with exposure to UVA to treat eczema,
and IARC classifies this as a cause of NMSC.66 Patients with
severe psoriasis may have seven times the NMSC risk of the
general population, and eleven times the malignant melanoma
risk, a cohort study showed.151
Malignant melanoma risk is apparently doubled in men with
Parkinsons disease, but there is no significant association for
women, a meta-analysis showed.152 A Danish cohort study
found a smaller effect (41% increase in men and women
combined) with similar magnitude in both sexes.153 NMSC
risk was 29% higher in Parkinsons disease patients in that
cohort study, but the meta-analysis found no significant
association.152,153
Rheumatoid arthritis patients taking tumour necrosis factor
inhibitors (anti-TNF-) may have increased NMSC risk, but
the evidence remains unclear: a meta-analysis of randomised
controlled trials found the effect was not significant,154 but a
meta-analysis of observational studies found a 45% higher risk
of NMSC.155 Rheumatoid arthritis patients taking anti-TNF- do
not have a higher NMSC risk than patients taking other diseasemodifiying anti-rheumatic drugs,156 nor does their malignant
melanoma risk appear to be significantly altered.155
People with HIV or AIDS have been shown to have increased
malignant melanoma and NMSC risks;144 presently IARC states
that there is limited evidence that HIV type 1 infection causes
NMSC.66

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future

5.10 Other risk factors


Taller women appear to be at increased risk of malignant
melanoma and BCC. One study showed women taller than
5 feet 3 inches were at 28-64% higher BCC risk than shorter
women; there was no effect of height for men.97 Malignant
melanoma risk increased by 32%-51% for every 10cm increase
in height, according to recent large studies.157,158

8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
14 of 20

Malignant melanoma risk is 31% higher in overweight (body


mass index BMI 25-29.9) and obese (BMI 30+) men,
compared with men whose BMI is lower than 25, a metaanalysis reported.159 This analysis showed the risk appears to
plateau in overweight men rather than continuing to increase
with higher BMI,159 however a previous meta-analysis found a
17% risk increase per 5-unit BMI increment.160

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Scotland (SC041666) and the Isle of Man (1103)

Risk factors

Case-control studies show that women with higher BMI or


body surface area have an increased malignant melanoma
risk, when results are adjusted for the amount of sun exposure,
suggesting mutual confounding between body size and
sun exposure (e.g. larger women self-limit their public sun
exposure).159 However, most studies have not adjusted for
amount of sun exposure and have not found an association
between overweight and malignant melanoma risk in
women.159-161 Obesity is associated with decreased NMSC
risk, perhaps due to less UV exposure in larger people.162,163
Women with BMI lower than 25kg/m2 were at 26-43% higher
BCC risk and 20-41% higher SCC risk than women with a
higher BMI, US cohort studies have shown.97,162 For men in
these analyses, the difference in BCC risk was only significant
for people with BMI 30-3499 versus BMI under 25, and there
was no significant effect of BMI on SCC risk.97,162 Babies with a
higher birthweight have a higher risk of early-onset malignant
melanoma, a Northern Ireland cohort study showed; those
weighing 4.5-6kg at birth had more than twice the malignant
melanoma risk compared with those weighing 3-3.5kg at
birth.164
There is sufficient evidence that X-radiation and gamma
radiation (both types of ionising radiation) cause NMSC,
according to IARC.66 Radiotherapy for a previous cancer is
estimated to have caused 17.9% of second primary malignant
melanoma cases in women and 2.8% of second primary
malignant melanoma cases in men in 2010.165 Exposure to
cosmic radiation has been posited as an explanation for the
higher rates of malignant melanoma in airline staff, but recent
evidence suggests that excessive UV exposure and sunsensitive skin phenotypes are more likely causes.166,167 People
who receive at least one computed tomography (CT) scan of
the brain before age 20 have a 14% higher risk of malignant
melanoma or NMSC, with no significant effect of CT scans
to other anatomical sites, a large Australian cohort study
showed.168
Some chemical exposures that can take place in certain
occupations cause NMSC, IARC states.66 These include coal
tar pitch, soot, mineral oils and shale oils. It has been estimated
that around 7% of NMSCs in men and around 1% in women
in Britain are due to occupational exposures (including solar
radiation).169
People diagnosed with genital warts (associated with infection
with HPV types 6 and 11) have a 30% increased risk of BCC.170

5.11 Factors shown to have no effect on


skin cancer risk
Use of oral contraceptives (OCs) or hormone replacement
therapy (HRT) does not significantly impact on malignant
melanoma risk in women, a meta-analysis shows.171 Other
reproductive factors (age at birth of first child, number of
children) show small effects on malignant melanoma risk,
though these effects are largely explained by socio-economic
factors.171 SCC risk increased by 35% for every five years of HRT
use in a cohort study, and BCC risk was 15% higher in women
who had ever used HRT compared to those who had never
used it.172 OC use did not impact on BCC or SCC risk in this
cohort study.172

Cancer
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Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

SKIN
CANCER
August 2013

Unlike for many other cancers, smoking does not appear


to increase malignant melanoma risk.66,173 The relationship
between smoking and NMSC risk remains unclear, with
effects apparently varying by NMSC type, and patient sex.173,174
Alcohol consumption does not appear to increase malignant
melanoma or NMSC risk overall.66,175

Risk factors to
Diagnosis and treatment

Low-fat diet does not appear to affect malignant melanoma


risk in women, a US cohort study showed.178 Folic acid
supplements were shown to have no effect on malignant
melanoma risk in the largest meta-analysis to date,179 Vitamin
A and carotenoids intake did not affect malignant melanoma
risk in a large cohort study.180

Non-steroidal anti-inflammatory drugs (NSAIDs) appear not


to affect malignant melanoma risk, meta-analyses show.176,177
Case-control studies indicate aspirin may slightly reduce
malignant melanoma risk, but no effect is seen in cohort
studies and because of the potential adverse consequences
of high intake of aspirin, such as gastrointestinal haemorrhage,
it would not be recommended as a prophylactic measure.176,177

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

DIAGNOSIS AND TREATMENT

6

6.1 How skin cancer is diagnosed
In 2006-2008 in England, 68% of malignant melanoma
patients were diagnosed having been seen by a specialist
as a result of a GP referral (Figure 19).181 These were either
two week wait referrals (41%), or routine or urgent referrals
where the patient was not referred under the two-week
wait route (27%).181 Just 3% of malignant melanoma patients
were diagnosed after presenting as an emergency: either via
the Accident & Emergency department; other emergency
hospital admission, attendance or transfer; or emergency GP/
consultant referral.181

Figure 19: Malignant Melanoma Routes to Diagnosis

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

0%

Percentage of Patients
25%
50%
75%

100%

Two-week wait
GP referral
Other outpatients
Impatient elective
Emergency
presentation
Death
certificate only
Screen detected
Unknown
Malignant melanoma (C43), routes to diagnosis, persons, England, 2006-2008.
Screen detected: Flagged by cancer registry as detected via breast or cervical
screening programme. Two Week Wait: Urgent GP referrals with a suspicion of
cancer. GP/outpatient referral: Routine and urgent referrals where the patient
was not referred under the Two Week Wait referral route. Other outpatient: An
elective route starting with an outpatient appointment that is either a consultant
to consultant referral, other referral, self-referral, dental referral or unknown
referral. Inpatient elective: Where no earlier information can be found prior to
admission from a waiting list, booked or planned. Emergency presentation:
An emergency route via A&E, emergency GP referral, emergency consultant
outpatient referral, emergency transfer, emergency admission or attendance.
Death certificate only: Diagnosis by death certificate only. Unknown: No data
available from inpatient or outpatient HES or from cancer waiting times or
screening.

9 How

information on
skin cancer
is recorded in
the UK

References

Page
15 of 20

The National Institute for Health and Clinical Excellence


Improving Outcomes Guidance (NICE IOG) for skin cancer
states that patients who present to primary care with a
possible cancerous skin lesion should either be treated by a
sufficiently-qualified GP (in the case of low-risk BCC or in situ
SCC) or referred to a specialist (in the case of SCC or malignant
melanoma).182,183

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Scotland (SC041666) and the Isle of Man (1103)

In the 2011/12 Cancer Patient Experience Survey, 89% of


malignant melanoma patients reported having seen their
GP about the health problem caused by cancer no more
than twice before being referred to hospital.184 In 2011/12 in
England, 95% of patients with a two-week wait GP referral
for suspected skin cancer (excluding BCC) were seen by a
specialist within two weeks (14 days) of referral.185
The majority of men and women diagnosed with malignant
melanoma present at stage I (see Section 2.6). Sentinel lymph
node biopsy is considered by many specialists to be a useful
staging tool in melanoma, but less than 10% of malignant
melanoma cases in 2005-2009 in England had this procedure,
it is estimated.186

6.2 Key treatments


6.2.1 Malignant melanoma
The first-line treatment for malignant melanoma is surgery
(wide local excision), the NICE IOG states.182,183 Radiotherapy
can be used with curative intent for melanoma in situ or
palliatively (often alongside chemotherapy) for metastatic
malignant melanoma. Some patients may receive supportive
care and observation only.182
In the 2011/12 Cancer Patient Experience Survey, 86% of
malignant melanoma patients said they were given a choice
of different types of treatment, and 76% felt their views were
definitely taken into account by the team discussing their
treatment.184

6.2.2 Non-melanoma skin cancer


Surgical removal is also the first-line treatment for NMSC,
though other surgical and non-surgical techniques may
be used instead of, or alongside, including: cautery or
electrodessication (electrical or chemical burning of the
tumour); cryotherapy/cryosurgery (freezing of the tumour
using liquid nitrogen); topical treatment (applying a cream such
as Imiquimod or Fluorouracil); photodynamic therapy (PDT,
using light therapy in combination with a photosensitising
cream to destroy cancer cells); and radiotherapy (often
using superficial X-ray machines, though linear accelerator
treatments are becoming more common).182,183

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

SKIN
CANCER
August 2013

By stage at
diagnosis
In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors

Diagnosis and treatment to


Acknowledgements

6.3 Clinical trials


In 2011/12, 19 skin cancer trials in the National Institute for
Health Research portfolio were open and recruiting in the
UK: 13 for melanoma (all types), 5 for NMSC, and 1 for all skin
cancers.187 There were also 9 funded trials in the process of
being set up: 7 for melanoma, 1 for NMSC, and 1 for all skin
cancers.187 Most of these trials focused on first- or second-line
treatments, and include a trial looking at nilotinib to treat acral
and mucosal melanoma skin cancer that has spread (NICAM),
and a study looking at high blood pressure and pazopanib
treatment (HYPAZ).

2.5

2.6

It is difficult to calculate the exact proportion of skin cancer


patients participating in trials, because under-registration of

NMSC means the total number of eligible patients is unclear;


however, it is likely that recruitment of patients to skin cancer
trials is lower than in trials for cancer in general. In 2010/11
up to 4% of eligible skin cancer patients were entered into an
NIHR randomised controlled trial (RCT), and up to 6% were
entered into a non-RCT trial.188 In contrast, in 2011/12, an
estimated 23.1% of UK cancer patients across all tumour sites
participated in an NCRI portfolio clinical trial.189
The 2011/12 Cancer Patient Experience Survey found that
taking part in clinical trials was discussed with 27% of skin
cancer patients.184

THE FUTURE

Skin cancer patients today generally have a much better


prognosis compared with those diagnosed in previous decades,
thanks to increased awareness, earlier diagnosis, and advances
in treatment. But much more can be done.

Sunbed use, particularly in young people, is a completely


avoidable skin cancer risk factor. In 2008-2009 in England,
6% of 11-17 year olds said they had used a sunbed, and in
2008 in Northern Ireland, 5% of under-25s in Northern Ireland
reported currently using sunbeds.89,198 Cancer Research UK has
Skin cancer is essentially an avoidable disease. Prevention is
campaigned for tougher legislation on sunbed use by children
either primary (through reducing exposure to UV radiation) or
and adolescents, and since 2008 in Scotland, and 2011 in
secondary (by earlier diagnosis). At the forefront of prevention
England, Wales and Northern Ireland, it has been illegal for
efforts in the UK is SunSmart, a national skin cancer prevention
under-18s to use sunbeds.199-201 There is now some evidence
campaign.190 Launched by Cancer Research UK in 2003,
to suggest teenagers sunbed use is decreasing.202 It is too
SunSmart is a public health campaign made up of four key
early to see the effects of the legislation on the incidence of
elements: research, public communication, professional
skin cancer in the UK, but this should be seen in the coming
support and policy development. It aims to improve knowledge, years.
attitudes, and behaviour around preventing overexposure to
UV and/or sunburn, as well as promoting the benefits of early
As well as concentrating efforts on early diagnosis and
diagnosis. Children, teenagers and young adults, and men
prevention of skin cancer, better treatments and improved
are particularly important audiences for the campaign. Other
quality of care are also urgently needed.203 Survival from
public health organisations and charities promoting sun safety
malignant melanoma is consistently lower in men than
include the British Association of Dermatologists, Skcin and
women across all age groups, and is especially low in elderly
the Teenage Cancer Trust.191- 193 There are also numerous local
men.36 Improving the diagnosis and treatment of older
initiatives in the UK,194 though one survey in England showed
patients, and men in particular, is an ongoing challenge. Late
these are often a low priority work area with ad-hoc (usually
stage disease also remains very difficult to treat, and this will be
seasonal) activity rather than sustained intervention.195 This issue a major focus of research in the future.
needs to be addressed, since evidence from Australia suggests
long-term commitment and adequate resources for prevention
programmes are required to improve skin cancer outcomes.
196,197

ACKNOWLEDGEMENTS

6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

We would like to acknowledge the essential work of the


National Cancer Registration Service (part of Public Health
England) and the Office for National Statistics in England, and
the cancer registries in Wales, Scotland and Northern Ireland.
Population-based cancer data has been collected in most
regions of the UK since the early 1960s, and without this
cancer registration system there would be no incidence or
survival statistics.

References

Page
16 of 20

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

Cite this report as Cancer Research UK (2013). Cancer


Statistics Report: Skin Cancer.

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

SKIN
CANCER
August 2013
9

How information on skin cancer is recorded in the UK to


References

HOW INFORMATION ON SKIN CANCER


IS RECORDED IN THE UK

The UK is widely acknowledged as having one of the most


comprehensive cancer registration systems in the world, with
population-based cancer data being collected in most regions
of the UK since the early 1960s.204
From April 2013, the recording of cancer incidence and
survival data in England has been co-ordinated by the National
Cancer Registration Service, which is part of Public Health
England (an executive agency of the Department of Health).
There are eight regional cancer registration offices, with the
statistics for England as a whole being collated by the Office
for National Statistics.1 Wales, Scotland and Northern Ireland
each have one national cancer registry.2-4 Cancer registration
data are collected according to a common minimum dataset,
which includes hospital details, personal details (such as name,
sex, date of birth, NHS number and postcode), diagnostic
and tumour details (such as location of the tumour in the
body, and for some sites the tumours stage of advancement
at diagnosis), and death details (where relevant). Information
is obtained on a voluntary basis from a wide variety of
sources including hospitals, pathology laboratories, cancer
centres, treatment centres, hospices, private hospitals, cancer
screening programmes, other cancer registers, general
practices, nursing homes, death certificates, Hospital Episode
Statistics (HES) and Cancer Waiting Time (CWT) data.
Most cancer registration systems currently record tumours
using the International Classification of Diseases tenth revision

(ICD-10), which assigns codes largely based on topography


(location in the body) and behaviour (malignant, in situ,
benign, or unknown/uncertain).205 The ICD-10 codes
for malignant melanoma and NMSC are C43 and C44,
respectively. Melanomas can also occur in other body
organs, such as the eye, but these data are not shown
here. In this report the term malignant melanoma refers to
malignant melanoma of the skin only.
The recording of NMSC at cancer registries is known to be
incomplete.28,206 Many cancer registries record only the
first NMSC of each histological type (e.g. BCC or SCC) per
person, and information on small NMSCs treated in primary
care or the private sector may never reach the cancer
registries.29 An estimated 30-50% of BCC and around 30% of
SCC goes unrecorded, though this may vary by registry.30-33
Efforts to improve the recording of NMSC are ongoing.206
Cancer mortality statistics are derived from statutory death
registrations in England and Wales, Scotland and Northern
Ireland.56-58 Data are reported in ICD-10 according to the
underlying cause of death, which is determined using
information collected on the death certificate.g
g

Death certificates are set out in two parts: part I records the immediate
cause of death and any associated conditions leading up to the death;
part II records details of any other conditions which contributed to the
death (but were not part of the main sequence of events leading up to it).

REFERENCES

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

1. Data were provided by the Office for


National Statistics on request, June 2012.
Similar data can be found here: http://
www.ons.gov.uk/ons/search/index.html?n
ewquery=cancer+registrations
2. Data were provided by ISD Scotland
on request, April 2012. Similar data can
be found here: http://www.isdscotland.
org/Health-Topics/Cancer/Publications/
index.asp
3. Data were provided by the Welsh
Cancer Intelligence and Surveillance Unit
on request, April 2012. Similar data can
be found here: http://www.wales.nhs.uk/
sites3/page.cfm?orgid=242&pid=59080

4.5

4. Data were provided by the Northern


Ireland Cancer Registry on request, June
2012. Similar data can be found here:
http://www.qub.ac.uk/research-centres/
nicr/CancerData/OnlineStatistics/

5 Risk factors

5. Quinn M, Wood H, Cooper N,


Rowan S, eds., Cancer Atlas of the United
Kingdom and Ireland 19912000 Studies
on Medical and Population Subjects No.
68. London: ONS; 2005.

Nonmelanoma skin
cancer

6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
17 of 20

6. NCIN. Cancer Incidence and


Mortality by Cancer Network, UK, 2005.
London: NCIN; 2008
7. NCIN. Cancer e-Atlas. European
Age-Standardised Mortality Rates, UK
(England: former Primary Care Trusts:
Wales; Scotland: NHS Health Boards;
Northen Ireland: Health and Social Care
Trusts), 2009-2011.
8. Dennis LK. Analysis of the melanoma
epidemic, both apparent and real: data
from the 1973 through 1994 surveillance,
epidemiology, and end results program
registry. Arch Dermatol 1999;135(3):27580.
9. de Vries, E. and J. Willem Coebergh.,
Cutaneous malignant melanoma in
Europe. Eur J Cancer 2004;40(16):235566.
10. de Vries, E. and J.W. Coebergh.,
Melanoma incidence has risen in Europe
BMJ 2005; 331(7518):698.

11. Office for National Statistics Travel


Trends 2005. A report on the International
Passenger Survey. London: ONS; 2006.
12. Parkin DM, Mesher D, Sasieni P.
Cancers attributable to solar (ultraviolet)
radiation exposure in the UK in 2010. Brit J
Cancer 2011;105 (S2):S66-S69.

23. National Cancer Intelligence


Network (NCIN). Cancer incidence by
deprivation England, 1995-2004. London:
NCIN; 2008.
24. ISD Scotland. Cancer Statistics. Skin
Cancer. Accessed June 2012.

13. Lifetime risk was calculated by the


Statistical Information Team at Cancer
Research UK, 2012.

25. Welsh Cancer Intelligence and


Surveillance Unit. Cancer in Wales, 19952009: A Comprehensive Report. Cardiff:
WCISU; 2011.

14. Sasieni PD, Shelton J, OrmistonSmith N, et al. What is the lifetime risk
of developing cancer?: The effect of
adjusting for multiple primaries. Brit J
Cancer 2011;105(3):460-5.

26. Donnelly, DW, Gavin, AT, Comber


H. Cancer in Ireland 1994-2004: A
comprehensive report (PDF 7.77MB)
Northern Ireland Cancer Registry/National
Cancer Registry: Ireland; 2009.

15. Department of Health. Improving


outcomes: a strategy for cancer. London:
DoH; 2011.

27. National Cancer Intelligence


Network (NCIN). One, Five and Ten Year
Cancer Prevalence by Cancer Network
UK, 2006 London: NCIN; 2010.

16. The National Cancer Registration


Service, Eastern Office. Personal
communication.
17. National Cancer Intelligence
Network (NCIN). Mortality, Incidence and
gender - Malignant Melanoma. London:
NCIN; 2012.
18. Ferlay J, Shin HR, Bray F, Forman
D, Mathers C, Parkin DM. Estimates
of worldwide burden of cancer in
2008: GLOBOCAN 2008. Int J Cancer
2010;127:2893-917.
19. Ferlay J, Shin HR, Bray F, Forman
D, Mathers C, Parkin DM. GLOBOCAN
2008 v1.2. Cancer Incidence and Mortality
Worldwide: IARC Cancerbase No.10
[Internet]. Lyon, France: International
Agency for Research on Cancer; 2010.
Available from: http://globocan.iarc.fr.
Accessed May 2011.
20. IARC. World Cancer Report 2008.
Lyon: IARC; 2008.
21. Armstrong BK, Kricker A. How much
melanoma is caused by sun exposure?
Melanoma Res 1993;3(6):395-401.
22. European Age-Standardised rates
calculated by the Statistical Information
Team at Cancer Research UK, 2011 using
data from GLOBOCAN 2008 v1.2, IARC,
version 1.2. http://globocan.iarc.fr/

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

28. National Cancer Intelligence


Network (NCIN). Non-melanoma skin
cancer in England, Scotland, Northern
Ireland, and Ireland. London: NCIN; 2013.
29. National Cancer Intelligence
Network (NCIN). Rare Skin Cancer in
England. London: NCIN; 2011.
30. Brewster DH, Bhatti LA, Inglis JH,
Nairn ER, Doherty VR. Recent trends in
incidence of non-melanoma skin cancer
in the East of Scotland, 1992-2003. Brit J
Dermatol 2007;156:1295-1300.
31. de Vries E, Micallef R, Brewster DH,
et al. Population-based estimates of the
occurrence of multiple vs. first primary
basal cell carcinomas in 4 European
regions. Arch Dermatol 2012;148(3):347354.
32. Poirier V, Ives A, Hounsome L, et al.
The Role of the South West Public Health
Observatory as the Lead Cancer Registry
for Skin Cancer. Poster presented at The
British Association of Dermatologists NonMelanoma Skin Cancer Update Meeting,
London, February 2013.
33. South West Public Health
Observatory. Non-Melanoma Skin Cancer:
Estimates of cases. Bristol: South West
Public Health Observatory; 2010.

34. Madan V, Lear JT, Szeimies RM.


Non-melanoma skin cancer. Lancet
2010;375(9715):673-85.
35. Miller SJ, Alam M, Andersen J et al.
Basal cell and squamous cell skin cancers
J Natl Compr Canc Netw 2010;8(8):83664.
36. Office for National Statistics (ONS).
Cancer survival in England: Patients
diagnosed 2005-2009 and followed up to
2010. London: ONS; 2011.
37. Ten-year predicted survival estimates
were provided by the Cancer Research UK
Cancer Survival Group, London School
of Hygiene and Tropical Medicine on
request, December 2012.
38. Welsh Cancer Intelligence and
Surveillance Unit (WCISU). Cancer Survival
Trends in Wales 1985-2004. Cardiff:
WCISU; 2010.
39. Information Services Division
Scotland (ISD Scotland). Cancer Statistics.
Malignant melanoma of the skin.
Accessed September 2011.
40. Northern Ireland Cancer Registry
(NICR). Cancer Survival Online Statistics.
Malignant melanoma. Accessed
September 2011.
41. MacKie RM, Bray CA, Hole DJ,
et al. Incidence of and survival from
malignant melanoma in Scotland:
an epidemiological study. Lancet
2002;360:587-91.
42. National Cancer Intelligence
Network. Mortality, Incidence and Gender:
Malignant Melanoma - NCIN Data
Briefing. London: NCIN; 2012.
43. Department of Health. Improving
outcomes: a strategy for cancer. London:
Department of Health; 2011.

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT

SKIN
CANCER
August 2013

1 Introduction

44. Downing A, Newton-Bishop JA,


Forman D. Recent trends in cutaneous
malignant melanoma in the Yorkshire
region of England; incidence, mortality
and survival in relation to stage of disease,
1993-2003. Brit J Cancer 2006;95:91-5.

2 Incidence

45. Murray CS, Stockton DL, Doherty VR.


Thick melanoma: the challenge persists.
Brit J Dermatol 2005;152:104-9.

Contents

By country in
the UK

2.1

By age

2.2

Trends over
time

2.3

Lifetime risk

2.4

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

Prevalence

2.9

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

By age

3.2

Trends over
time

3.3

By stage at
diagnosis

3.4

In Europe

3.5

4 Mortality

By country in
the UK

4.1

By age

4.2

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future

46. The National Cancer Registration


Service, Eastern Office. Personal
communication.
47. Istituto Superiore di Sanit.
EUROCARE: Survival of Cancer Patients
in Europe. Rome, Italy: Istituto Superiore
di Sanit. Available from http://www.
eurocare.it/
48. Berrino F. The EUROCARE Study:
strengths, limitations and perspectives of
population-based, comparative survival
studies. Ann Oncol 2003;14 Suppl 5:v9-13.
49. Anderson WJ, Murtagh C. Cancer
survival statistics should be viewed with
caution. Lancet Oncol 2007;8:1052-3.
Author reply 1053-4.
50. Autier P, Boniol M, Hery C, Masuyer
E, Ferlay J. Cancer survival statistics should
be viewed with caution. Lancet Oncol
2007;8:1050-2. Author reply 1053-4.
51. Cancer Research UK science
blog. Controversy over European
cancer statistics. http://scienceblog.
cancerresearchuk.org/2007/08/23/
controversy-over-european-cancerstatistics/
52. Berrino F, De Angelis R, Sant M,
et al. Survival for eight major cancers
and all cancers combined for European
adults diagnosed in 1995-99: results of
the EUROCARE-4 study. Lancet Oncol
2007;8:773-83.
53. Sant M, Allemani C, Santaquilani
M, et al. EUROCARE-4. Survival of
cancer patients diagnosed in 1995-1999.
Results and commentary. Eur J Cancer
2009;45:931-91.
54. Welsh Cancer Intelligence and
Surveillance Unit. Investigating the low
survival for malignant melanoma of skin
and cervical cancer in Wales. Cardiff:
WCISU; 2011.
55. Abdel-Rahman M, Stockton D,
Rachet B, et al. What if cancer survival in
Britain were the same as in Europe: how
many deaths are avoidable? Brit J Cancer
2009;101:S115-S24.
56. Data were provided by the Office
for National Statistics on request. March
2013. Similar data can be found here:
http://www.ons.gov.uk/ons/publications/
all-releases.html?definition=tcm%
3A77-27475.
57. Data were provided by ISD Scotland
on request. March 2013. Similar data can
be found here: http://gro-scotland.gov.uk/
statistics/theme/vital-events/general/reftables/index.html.
58. Data were provided by the Northern
Ireland Cancer Registry on request. May
2013. Similar data can be found here:
http://www.nisra.gov.uk/demography/
default.asp22.html.
59. The Eastern Cancer Registration
and Information Centre (ECRIC) 2010,
personal communication. http://www.
ecric.org.uk/
60. World Health Organisation. Global
Health Observatory Data Repository.
Accessed July 2012.
61. Epstein EH. Basal cell carcinomas:
attack of the hedgehog. Nat Rev Cancer
2008;8(10):743-54.

8 Acknowledge-

62. Parkin DM, Mesher D, Sasieni P. 13.


Cancers attributable to solar (ultraviolet)
radiation exposure in the UK in 2010. Br J
Cancer 2011;105 Suppl 2:S66-9.

9 How

63. Leiter U, Garbe C. Epidemiology


of melanoma and nonmelanoma skin
cancer--the role of sunlight. Adv Exp Med
Biol 2008;624:89-103.

ments

information on
skin cancer
is recorded in
the UK

References

Page
18 of 20

64. Diffey B. Climate change, ozone


depletion and the impact on ultraviolet
exposure of human skin. Phys Med Biol
2004 Jan 7;49(1):R1-11.
65. International Agency for Research
on Cancer. Solar and ultraviolet radiation
(Vol 55). Monographs on the evaluation
of carcinogenic risks to humans. Lyon:
IARCPress; 1992.

References
66. Cogliano VJ, Baan R, Straif K, et
al. Preventable exposures associated
with human cancers. J Natl Cancer Inst
2011;103:1827-39.

85. Zhang M, Qureshi AA, Geller


AC, et al. Use of tanning beds and
incidence of skin cancer. J Clin Oncol
2012;30(14):1588-93.

67. Lucas RM, McMichael AJ, Armstrong


BK, et al. Estimating the global disease
burden due to ultraviolet radiation
exposure. International Journal of
Epidemiology 2008;37:654-67.

86. Ferrucci LM, Cartmel B, Molinaro


AM, et al. Indoor tanning and risk of earlyonset basal cell carcinoma. J Am Acad
Dermatol. 2011.

68. Gandini S, Sera F, Cattaruzza MS,


et al. Meta-analysis of risk factors for
cutaneous melanoma: II. Sun exposure.
European Journal of Cancer 2005;41:4560.
69. Elwood JM, Jopson J. Melanoma
and sun exposure: an overview
of published studies. Int J Cancer
1997;73:198-203.
70. Olsen CM, Zens MS, Green AC,
et al. Biologic markers of sun exposure
and melanoma risk in women: Pooled
casecontrol analysis. Int J Cancer
2011;129:713-23.

87. Lazovich D, Vogel RI, Berwick M, et


al. Indoor Tanning and Risk of Melanoma:
A Case-Control Study in a Highly Exposed
Population. Cancer Epidemiol Biomarkers
Prev 2010;19:1557-68.
88. Office for National Statistics. ONS
Omnibus Survey, Knowledge of the Solar
UV Index. 2000.
89. Thomson CS, Woolnough S,
Wickenden M, et al. Sunbed use in
children aged 11-17 in England: face
to face quota sampling surveys in the
National Prevalence Study and Six Cities
Study. BMJ 2010;340.

71. Dennis LK, Vanbeek MJ, Beane


Freeman LE, et al. Sunburns and risk of
cutaneous melanoma: does age matter?
A comprehensive meta-analysis. Ann
Epidemiol 2008;18:614-27.

90. Boyle R, OHagan AH, Donnelly


D, et al. Trends in reported sun bed use,
sunburn, and sun care knowledge and
attitudes in a U.K. region: results of a
survey of the Northern Ireland population.
Br J Dermatol 2010;163:1269-75.

72. Pelucchi C, Di Landro A, Naldi L, et


al. Risk factors for histological types and
anatomic sites of cutaneous basal-cell
carcinoma: an italian case-control study. J
Invest Dermatol 2007;127:935-44.

91. International Commission on


Non-Ionizing Radiation Protection. Health
issues of ultraviolet tanning appliances
used for cosmetic purposes. Health Phys
2003;84:119-27.

73. Corona R, Dogliotti E, D'Errico M, et


al. Risk factors for basal cell carcinoma
in a Mediterranean population: role of
recreational sun exposure early in life.
Arch Dermatol 2001;137:1162-8.

92. World Health Organization. Artificial


tanning sunbeds: risk and guidance. 2003.

74. Zanetti R, Rosso S, Martinez C, et al.


Comparison of risk patterns in carcinoma
and melanoma of the skin in men: a
multi-centre case-case-control study. Br J
Cancer 2006;94:743-51.
75. Rosso S, Zanetti R, Martinez C,
et al. The multicentre south European
study 'Helios'. II: Different sun exposure
patterns in the aetiology of basal cell and
squamous cell carcinomas of the skin. Br
J Cancer 1996;73:1447-54.
76. Steding-Jessen M, Birch-Johansen
F, Jensen A, et al. Socioeconomic status
and non-melanoma skin cancer: A
nationwide cohort study of incidence and
survival in Denmark. Cancer Epidemiology
2010;34:689-95.
77. Bauer A, Diepgen TL, Schmitt J. Is
occupational solar ultraviolet irradiation
a relevant risk factor for basal cell
carcinoma? A systematic review and
meta-analysis of the epidemiological
literature. Br J Dermatol 2011;165:612-25.
78. Schmitt J, Seidler A, Diepgen TL,
Bauer A. Occupational ultraviolet light
exposure increases the risk for the
development of cutaneous squamous cell
carcinoma: a systematic review and metaanalysis. Br J Dermatol 2011;164:291-307.
79. Boniol M, Autier P, Boyle P, et al.
Cutaneous melanoma attributable to
sunbed use: systematic review and
meta-analysis. BMJ 2012;345:e4757 doi:
10.1136/bmj.e4757.
80. Boniol M, Autier P, Boyle P, Gandini
S. Correction to Cutaneous melanoma
attributable to sunbed use: systematic
review and meta-analysis. BMJ
2012;345:e8503.
81. Veierod MB, Adami HO, Lund E,
et al. Sun and solarium exposure and
melanoma risk: effects of age, pigmentary
characteristics, and nevi. Cancer
Epidemiol Biomarkers Prev 2010;19:11120.
82. Nielsen K, Msbck A, Olsson H,
Ingvar C. A prospective, populationbased study of 40,000 women regarding
host factors, UV exposure and sunbed
use in relation to risk and anatomic site
of cutaneous melanoma. Int J Cancer
2012;131(3):706-15.
83. Diffey BL. A quantitative estimate
of melanoma mortality from ultraviolet
A sunbed use in the U.K. Br J Dermatol
2003;149:578-81.
84. Wehner MR, Shive ML, Chren MM,
et al. Indoor tanning and non-melanoma
skin cancer: systematic review and
meta-analysis. BMJ 2012;345:e5909. doi:
10.1136/bmj.e5909.

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

93. Olsen CM, Carroll HJ, Whiteman


DC. Estimating the attributable fraction for
melanoma: a meta-analysis of pigmentary
characteristics and freckling. Int J Cancer
2010;127:2430-45.
94. Fitzpatrick T. Soleil et peau. J Med
Esthet 1975;2:33-4.
95. Williams PF, Olsen CM, Hayward NK,
et al. Melanocortin 1 receptor and risk of
cutaneous melanoma: a meta-analysis
and estimates of population burden. Int J
Cancer 2011;129:1730-40.
96. Bauer J, Garbe C. Acquired
Melanocytic Nevi as Risk Factor
for Melanoma Development.
A Comprehensive Review of
Epidemiological Data. Pigment Cell Res
2003;16:297-306.
97. Gerstenblith MR, Rajaraman P,
Khaykin E, et al. Basal cell carcinoma
and anthropometric factors in the U.S.
radiologic technologists cohort study. Int
J Cancer 2012;131:E149-E55.
98. Gerstenblith MR, Shi J, Landi MT.
Genome-wide association studies
of pigmentation and skin cancer: a
review and meta-analysis. Pigment Cell
Melanoma Res 2010;23:587-606.
99. Kiiski V, de Vries E, Flohil SC, et
al. Risk factors for single and multiple
basal cell carcinomas. Arch Dermatol
2010;146:848-55.
100. Rosso S, Zanetti R, Martinez C,
et al. The multicentre south European
study 'Helios'. I: Skin characteristics and
sunburns in basal cell and squamous
cell carcinomas of the skin. Br J Cancer
1996;73:1440-6.
101. Gandini S, Sera F, Cattaruzza
MS, et al. Meta-analysis of risk factors
for cutaneous melanoma: I. Common
and atypical naevi. European Journal of
Cancer 2005;41:28-44.
102. Olsen CM, Carroll HJ, Whiteman
DC. Estimating the attributable fraction
for cancer: A meta-analysis of nevi and
melanoma. Cancer Prev Res (Phila)
2010;3:233-45.
103. Greene MH, Clark JWH, Tucker MA,
et al. High risk of malignant melanoma in
melanoma-prone families with dysplastic
nevi. Annals of Internal Medicine
1985;102:458-65.
104. Dulon M, Weichenthal M, Blettner
M, et al. Sun exposure and number
of nevi in 5- to 6-year-old European
children. Journal of Clinical Epidemiology
2002;55:1075-81.
105. Wachsmuth RC, Gaut RM,
Barrett JH, et al. Heritability and geneenvironment interactions for melanocytic
nevus density examined in a U.K.
adolescent twin study. J Invest Dermatol.
2001;117:348-52.

106. Chesnut C, Kim J. Is there truly


no benefit with sunscreen use and Basal
cell carcinoma? A critical review of the
literature and the application of new
sunscreen labeling rules to real-world
sunscreen practices. J Skin Cancer
2012;2012:480985.
107. Diffey BL. Sunscreens as a
preventative measure in melanoma:
an evidence-based approach or the
precautionary principle? Br J Dermatol
2009;161:25-7.
108. Weinstock MA. Do sunscreens
increase or decrease melanoma risk:
an epidemiologic evaluation. J Investig
Dermatol Symp Proc 1999;4:97-100.
109. Autier P, Boniol M, Dore JF.
Sunscreen use and increased duration of
intentional sun exposure: still a burning
issue. Int J Cancer 2007;121:1-5.
110. Dennis LK, Beane Freeman
LE, VanBeek MJ. Sunscreen use and
the risk for melanoma: A quantitative
review. Annals of Internal Medicine
2003;139:966-78.
111. International Agency for Research
on Cancer. IARC Handbook on Cancer
Prevention Vol.5: Sunscreens. 2001.
112. Lee JE, Li H, Chan AT, et al.
Circulating levels of vitamin D and colon
and rectal cancer: the Physicians' Health
Study and a meta-analysis of prospective
studies. Cancer Prev Res (Phila)
2011;4:735-43.
113. Ma Y, Zhang P, Wang F, et al.
Association Between Vitamin D and Risk
of Colorectal Cancer: A Systematic Review
of Prospective Studies. Journal of Clinical
Oncology 2011;29:3775-82.
114. Mohr SB, Gorham ED, Alcaraz
JE, et al. Serum 25-hydroxyvitamin D
and prevention of breast cancer: pooled
analysis. Anticancer Res 2011;31:2939-48.
115. Gandini S, Boniol M, Haukka J, et
al. Meta-analysis of observational studies
of serum 25-hydroxyvitamin D levels and
colorectal, breast and prostate cancer
and colorectal adenoma. Int J Cancer
2011;128:1414-24.
116. Chung M, Lee J, Terasawa T, et
al. Vitamin D With or Without Calcium
Supplementation for Prevention of Cancer
and Fractures: An Updated Meta-analysis
for the U.S. Preventive Services Task Force.
Ann Intern Med 2011;155:827-38.
117. International Agency for Research
on Cancer. IARC Working Group Reports
Volume 5: Vitamin D and Cancer. Geneva:
International Agency for Research on
Cancer. 2008.
118. Webb AR, DeCosta BR, Holick
MF. Sunlight regulates the cutaneous
production of vitamin D3 by causing its
photodegradation. J Clin Endocrinol
Metab 1989;68:882-7.
119. Olsen CM, Carroll HJ, Whiteman
DC. Familial melanoma: a meta-analysis
and estimates of attributable fraction.
Cancer Epidemiol Biomarkers Prev
2010;19:65-73.
120. Gandini S, Sera F, Cattaruzza MS,
et al. Meta-analysis of risk factors for
cutaneous melanoma: III. Family history,
actinic damage and phenotypic factors.
Eur J Cancer 2005;41:2040-59.
121. Law MH, Macgregor S, Hayward
NK. Melanoma genetics: recent findings
take us beyond well-traveled pathways. J
Invest Dermatol 2012;132:1763-74.
122. Hansen CB, Wadge LM, Lowstuter
K, et al. Clinical germline genetic testing
for melanoma. Lancet Oncol 2004;5:3149.
123. Bonadies DC, Bale AE. Hereditary
melanoma. Current Problems in Cancer
2011;35:162-72.
124. Bishop DT, Demenais F, Goldstein
AM, et al. Geographical variation in
the penetrance of CDKN2A mutations
for melanoma. J Natl Cancer Inst
2002;94:894-903.
125. Schneider K GJ. Li-Fraumeni
Syndrome. In: Pagon RA BT, Dolan CR, et
al., editors, ed. GeneReviews [Internet].
Seattle (WA): University of Washington;
1999 Jan 19 [Updated 2010 Feb 9].

Cancer
Cancer
Statistics
Statistics

REPORT
REPORT
Contents
1 Introduction
2 Incidence

By country in
the UK

2.1

2.2

By age

Trends over
time

2.3

2.4

Lifetime risk

Distribution of
cases

2.5

By stage at
diagnosis

2.6

In Europe and
worldwide

2.7

Socioeconomic
variation

2.8

2.9

Prevalence

2.10 Non-

melanoma skin
cancer

3 Survival

One-, fiveand ten-year


survival

3.1

3.2

By age

Trends over
time

3.3

By stage at
diagnosis

3.4
3.5

In Europe

4 Mortality

By country in
the UK

4.1

4.2

By age

Trends over
time

4.3

In Europe and
worldwide

4.4

Nonmelanoma skin
cancer

4.5

5 Risk factors
6 Diagnosis and

treatment

7 The future
8 Acknowledge-

ments

9 How

information on
skin cancer
is recorded in
the UK

References

Page
19 of 20

SKIN
CANCER
August 2013
126. Hemminki K, Zhang H, Czene K.
Time trends and familial risks in squamous
cell carcinoma of the skin. Arch Dermatol
2003;139:885-9.
127. Qureshi AA, Zhang M, Han J.
Heterogeneity in host risk factors for
incident melanoma and non-melanoma
skin cancer in a cohort of US women. J
Epidemiol 2011;21:197-203.
128. Balamurugan A, Rees JR, Kosary
C, et al. Subsequent primary cancers
among men and women with in situ and
invasive melanoma of the skin. J Am Acad
Dermatol 2011;65:S69-77.
129. Bradford PT, Freedman DM,
Goldstein AM, et al. Increased risk
of second primary cancers after a
diagnosis of melanoma. Arch Dermatol
2010;146:265-72.
130. van der Leest RJ, Liu L, Coebergh
JW, et al. Risk of second primary in
situ and invasive melanoma in a Dutch
population-based cohort: 1989-2008. Br J
Dermatol 2012;167(6):1321-30.
131. Zhang H, Bermejo JL, Sundquist
J, et al. Modification of second cancer
risk after malignant melanoma by
parental history of cancer. Br J Cancer
2008;99:536-8.
132. Yang GB, Barnholtz-Sloan JS, Chen
Y, et al. Risk and Survival of Cutaneous
Melanoma Diagnosed Subsequent to a
Previous Cancer. Archives of Dermatology
2011;147:1395-402.
133. Goggins W, Gao W, Tsao H.
Association between female breast cancer
and cutaneous melanoma. Int J Cancer
2004;111:792-4.
134. Pirani M, Marcheselli R, Marcheselli
L, et al. Risk for second malignancies
in non-Hodgkins lymphoma survivors:
a meta-analysis. Annals of Oncology
2011;22:1845-58.
135. Morton LM, Curtis RE, Linet MS,
et al. Second Malignancy Risks After
Non-Hodgkin's Lymphoma and Chronic
Lymphocytic Leukemia: Differences by
Lymphoma Subtype. Journal of Clinical
Oncology 2010;28:4935-44.
136. Braam KI, Overbeek A, Kaspers
GJL, et al. Malignant melanoma as
second malignant neoplasm in longterm childhood cancer survivors: A
systematic review. Pediatric Blood Cancer
2012;58:665-74.
137. Pappo AS, Armstrong GT, Liu W, et
al. Melanoma as a subsequent neoplasm
in adult survivors of childhood cancer:
a report from the childhood cancer
survivor study. Pediatr Blood Cancer
2013;60(3):461-6.
138. Braisch U, Meyer M, RadespielTroger M. Risk of subsequent primary
cancer among prostate cancer patients in
Bavaria, Germany. Eur J Cancer Prev 2012.
139. Marcil I, Stern RS. Risk of developing
a subsequent nonmelanoma skin cancer
in patients with a history of nonmelanoma
skin cancer. A critical review of the
literature and meta-analysis. Archives of
Dermatology 2000;136:1524-30.
140. Levi F, Randimbison L, Maspoli M,
et al. High incidence of second basal cell
skin cancers. Int J Cancer 2006;119:15057.
141. Hemminki K, Jiang Y, Steineck
G. Skin cancer and non-Hodgkin's
lymphoma as second malignancies.
markers of impaired immune function?
Eur J Cancer 2003;39:223-9.
142. Crocetti E, Guzzinati S, Paci E, et al.
The risk of developing a second, different,
cancer among 14 560 survivors of
malignant cutaneous melanoma: a study
by AIRTUM (the Italian Network of Cancer
Registries). Melanoma Res 2008;18:230-4.
143. Wheless L, Black J, Alberg AJ.
Nonmelanoma skin cancer and the risk
of second primary cancers: a systematic
review. Cancer Epidemiol Biomarkers Prev
2010;19:1686-95.
144. Grulich AE, van Leeuwen MT,
Falster MO, et al. Incidence of cancers
in people with HIV/AIDS compared with
immunosuppressed transplant recipients:
a meta-analysis. Lancet;370:59-67.
145. Moloney FJ, Comber H, O'Lorcain
P, et al. A population-based study of
skin cancer incidence and prevalence in
renal transplant recipients. Br J Dermatol
2006;154:498-504.

References
146. Zwald FO, Christenson LJ,
Billingsley EM, et al. Melanoma in solid
organ transplant recipients. American
Journal of Transplantation 2010;10:1297304.
147. Singh S, Nagpal SJ, Murad MH,et al.
Inflammatory Bowel Disease Is Associated
With an Increased Risk of Melanoma: A
Systematic Review and Meta-Analysis. Clin
Gastroenterol Hepatol 2013 doi: 10.1016/j.
cgh.2013.04.033.
148. Arana A, Wentworth CE, FernndezVidaurre C, et al. Incidence of cancer in
the general population and in patients
with or without atopic dermatitis in the
U.K. Br J Dermatol 2010;163:1036-43.
149. Jensen AO, Svaerke C, Kormendine
Farkas D, et al. Atopic dermatitis and risk of
skin cancer: a Danish nationwide cohort
study (1977-2006). Am J Clin Dermatol
2012;13:29-36.
150. Engkilde K, Thyssen JP, Menne T,
et al. Association between cancer and
contact allergy: a linkage study. BMJ Open
2011;1:e000084.
151. Lee MS, Lin RY, Chang YT, Lai MS.
The risk of developing non-melanoma
skin cancer, lymphoma and melanoma in
patients with psoriasis in Taiwan: a 10-year,
population-based cohort study. Int J
Dermatol 2012;51(12):1454-60.
152. Lee MS, Lin RY, Chang YT, Lai MS.
The risk of developing non-melanoma
skin cancer, lymphoma and melanoma in
patients with psoriasis in Taiwan: a 10-year,
population-based cohort study. Int J
Dermatol 2012;51(12):1454-60.
153. Rugbjerg K, Friis S, Lassen CF, Ritz
B, Olsen JH. Malignant melanoma, breast
cancer and other cancers in patients
with Parkinson's disease. Int J Cancer
2012;131(8):1904-11.
154. Moulis G, Sommet A, Bn
J, et al. Cancer risk of anti-TNF- at
recommended doses in adult rheumatoid
arthritis: a meta-analysis with intention to
treat and per protocol analyses. PLoS One
2012;7(11):e48991.
155. Mariette X, Matucci-Cerinic M,
Pavelka K, et al. Malignancies associated
with tumour necrosis factor inhibitors in
registries and prospective observational
studies: a systematic review and metaanalysis. Ann Rheum Dis 2011;70:1895904.
156. Le Blay P, Mouterde G, Barnetche
T, et al. Risk of malignancy including
non-melanoma skin cancers with antitumor necrosis factor therapy in patients
with rheumatoid arthritis: meta-analysis
of registries and systematic review of
long-term extension studies. Clin Exp
Rheumatol 2012.
157. Green J, Cairns BJ, Casabonne D,
et al. Height and cancer incidence in the
Million Women Study: prospective cohort,
and meta-analysis of prospective studies
of height and total cancer risk. Lancet
Oncol 2011;12:785-94.
158. Kabat GC, Heo M, Kamensky V, et
al. Adult height in relation to risk of cancer
in a cohort of Canadian women. Int J
Cancer 2012. doi: 10.1002/ijc.27704.
159. Sergentanis TN, Antoniadis AG,
Gogas HJ, et al. Obesity and risk of
malignant melanoma: a meta-analysis
of cohort and case-control studies. Eur J
Cancer 2013;49(3):642-57.
160. Renehan AG, Tyson M, Egger M,
et al. Body-mass index and incidence of
cancer: a systematic review and metaanalysis of prospective observational
studies. Lancet 2008;371:569-78.
161. Olsen CM, Green AC, Zens MS,
et al. Anthropometric factors and risk of
melanoma in women: A pooled analysis.
Int J Cancer 2008;122:1100-8.
162. Pothiawala S, Qureshi A, Li Y, et al.
Obesity and the incidence of skin cancer
in US Caucasians. Cancer Causes and
Control 2012;23:717-26.
163. Pothiawala S, Qureshi AA, Li Y,
Han J. Obesity and the incidence of skin
cancer in US Caucasians. Cancer Causes
Control 2012;23(5):717-26.
164. O'Rorke MA, Black C, Murray LJ, et
al. Do perinatal and early life exposures
influence the risk of malignant melanoma?
A Northern Ireland birth cohort analysis.
Eur J Cancer 2013;49(5):1109-16.

cruk.org/cancerstats
Cancer Research UK 2013 Registered charity in England and Wales (1089464),
Scotland (SC041666) and the Isle of Man (1103)

165. Parkin DM, Darby SC. 12. Cancers


in 2010 attributable to ionising radiation
exposure in the UK. Br J Cancer 2011;105
Suppl 2:S57-65.
166. Dos Santos Silva I, De Stavola
B, Pizzi C, et al. Cancer incidence in
professional flight crew and air traffic
control officers: Disentangling the effect
of occupational versus lifestyle exposures.
Int J Cancer 2012.
167. Tokumaru O, Haruki K, Bacal K, et
al. Incidence of cancer among female
flight attendants: a meta-analysis. J Travel
Med 2006;13(3):127-32.
168. Mathews JD, Forsythe AV, Brady
Z, et al. Cancer risk in 680 000 people
exposed to computed tomography
scans in childhood or adolescence: data
linkage study of 11 million Australians. BMJ
2013;346 doi: 10.1136/bmj.f2360.
169. Young C, Rushton L. Occupational
cancer in Britain: Skin cancer. Br J Cancer
2012;107 Suppl 1:S71-5.
170. Blomberg M, Friis S, Munk C,
et al. Genital warts and risk of cancer:
a Danish study of nearly 50 000
patients with genital warts. J Infect Dis
2012;205(10):1544-53.
171. Gandini S, Iodice S, Koomen E, et
al. Hormonal and reproductive factors in
relation to melanoma in women: Current
review and meta-analysis. European
Journal of Cancer 2011;47:2607-17.
172. Birch-Johansen F, Jensen A, Olesen
AB, et al. Does hormone replacement
therapy and use of oral contraceptives
increase the risk of non-melanoma
skin cancer? Cancer Causes Control
2012;23(2):379-88.
173. Song F, Qureshi AA, Gao X, Li T,
Han J. Smoking and risk of skin cancer: a
prospective analysis and a meta-analysis.
Int J Epidemiol 2012;41(6):1694-705.
174. Leonardi-Bee J, Ellison T,
Bath-Hextall F. Smoking and the Risk of
Nonmelanoma Skin Cancer: Systematic
Review and Meta-analysis. Arch Dermatol
2012:1-8.
175. Jensen A, Birch-Johansen F, Olesen
AB, et al. Intake of alcohol may modify the
risk for non-melanoma skin cancer: results
of a large Danish prospective cohort study.
J Invest Dermatol 2012;132(12):2718-26.
176. Li S, Liu Y, Zeng Z, et al. Association
between non-steroidal anti-inflammatory
drug use and melanoma risk: a metaanalysis of 13 studies. Cancer Causes
Control May 2013 doi: 10.1007/s10552013-0227-8.
177. Hu H, Xie Y, Yang G, Jian C, Deng
Y. Nonsteroidal anti-inflammatory drug
use and the risk of melanoma: a metaanalysis. Eur J Cancer Prev 2013 doi:
178. Gamba CS, Stefanick M, Shikany J,
et al. Low fat diet and skin cancer risk: the
Women's Health Initiative Randomized
Controlled Dietary Modification Trial.
Cancer Epidemiol Biomarkers Prev 2013.
179. Vollset SE, Clarke R, Lewington S, et
al. Effects of folic acid supplementation on
overall and site-specific cancer incidence
during the randomised trials: metaanalyses of data on 50,000 individuals.
Lancet 2013;381(9871):1029-36.
180. Asgari MM, Brasky TM, White E.
Association of vitamin A and carotenoid
intake with melanoma risk in a large
prospective cohort. J Invest Dermatol
2012:132(6);1573-8
181. National Cancer Intelligence
Network. Routes to Diagnosis, 20062008: NCIN information supplement.
London: NCIN; 2012.
182. National Institute for Health and
Clinical Excellence. Improving outcomes
for people with skin tumours including
melanoma: the manual (2006 guidance).
London: NICE; 2006.
183. National Institute for Health and
Clinical Excellence. Improving outcomes
for people with skin tumours including
melanoma (update): the management
of low-risk basal cell carcinomas in
the community (2010 partial guidance
update). London: NICE; 2010
184. Department of Health. Cancer
Patient Experience Survey 2011/12:
National Report. London: DH; 2012.
185. Department of Health. Waiting
Times for Suspected and Diagnosed

Cancer Patients: 2011-12 Annual Report.


London: DH; 2012.

186. National Cancer Intelligence


Network. Baseline assessment of sentinel
lymph node biopsy practice across
England for melanoma patients, 20052009. London: NCIN; 2012.
187. National Cancer Research Institute.
NCRI Melanoma Clinical Studies Group
Annual Report 2011-2012. London: NCRI:
2012.
188. Recruitment to NIHR trials
calculated by Cancer Research UK
Statistical Information team, based
on number of UK patients recruited
to NIHR trials in financial year 2011/12
(National Cancer Research Institute. NCRI
Melanoma Clinical Studies Group Annual
Report 2011-2012. London: NCRI: 2012. )
and annual average number of UK cases
recorded in 2010.
189. National Cancer Research Institute.
NCRI Operating Report 2011/12. London:
NCRI: 2012.
190. Cancer Research UK. SunSmart
- Skin Cancer Information and Sun
Protection Advice. Accessed July 2013.
191. British Association of
Dermatologists Sun Awareness
Campaign. Accessed July 2013.
192. Skcin The Karen Clifford Skin
Cancer Charity. Accessed July 2013.
193. Teenage Cancer Trust - Shunburn.
Accessed July 2013.
194. Public Health England Knowledge
and Intelligence Team (South West). Skin
Cancer Hub Interventions database.
Accessed July 2013.
195. Halliday J and Asthana S. Skin
cancer prevention initiatives in England:
Results of a survey conducted by the
Peninsula Cancer Network. Plymouth:
Peninsula Cancer Network and the
University of Plymouth; 2010.
196. National Institute for Health and
Care Excellence (NICE). Skin cancer
prevention: information, resources and
environmental changes: Expert paper 3:
National campaigns (UK and worldwide).
London: NICE; 2011.
197. Dobbinson SJ, Wakefield MA,
Jamsen KM, et al. Weekend Sun
Protection and Sunburn in Australia:
Trends (1987-2002) and Association
with SunSmart Television Advertising.
American Journal of Preventive Medicine
(2008);34(2):94-101.
198. Boyle R, OHagan AH, Donnelly
D, et al. Trends in reported sun bed use,
sunburn, and sun care knowledge and
attitudes in a U.K. region: results of a
survey of the Northern Ireland population.
Br J Dermatol 2010;163: 1269-75.
199. The Scottish Government.
Public Health etc. (Scotland) Act 2008.
Edinburgh: The Scottish Government;
2008.
200. HM Government. Sunbeds
(Regulation) Act 2010. London: The
Stationery Office Limited; 2010.
201. Department of Health, Social
Services and Public Safety. Sunbeds
Act (Northern Ireland) 2011. Belfast:
DHSSPSNI; 2012.
202. Lee SI, Macherianakis A, Roberts
LM. Sunbed Use, Attitudes, and
Knowledge After the Under-18s Ban: A
School-Based Survey of Adolescents
Aged 15 to 17 Years in Sandwell, United
Kingdom. J Prim Care Community Health
2013 doi: 10.1177/2150131913482142.
203. The Melanoma Taskforce. Quality in
Melanoma Care: A best practice pathway.
2012.
204. UK Association of Cancer
Registries. About Registration: What is
cancer registration? http://www.ukacr.org/
content/about-registration. 2012.
205. World Health Organisation.
International Statistical Classification of
Diseases and Related Health Problems.
10th Revision. Geneva: World Health
Organisation; 2010.
206. National Cancer Intelligence
Network (NCIN) Data Briefing. The
Importance of Skin Cancer Registration.
London: NCIN; 2010.

SKIN CANCER

August 2013

CANCER RESEARCH UK
CANCER STATISTICS
Written for health professionals, we provide cancer statistics
for the UK and around the world.
We have data for more than 30 common cancers including:
Incidence, survival and
mortality stats

Prevalence and lifetime


risk estimates

Variation by age, ethnicity


and socio-economic
group

Risk factors evidence


Treatment, screening
and clinical trials stats

Over 650 charts, tables, PowerPoint slides, reports, briefings


and Key Facts publications give top-line cancer stats or
in-depth analyses and interpretation about cancer statistics in
the UK and around the world, and are all free to download.

cruk.org/cancerstats

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