Cancer Causes & Control

, Volume 19, Issue 8, pp 879–885 | Cite as

Deaths from non-melanoma skin cancer in Western Australia

  • J. Girschik
  • Lin Fritschi
  • T. Threlfall
  • T. Slevin
Original Paper



Non-melanoma skin cancer (NMSC) is common, slow growing, and rarely metastasizes. However, there are still nearly 400 deaths from NMSC in Australia annually. We aimed to investigate the accuracy of NMSC death coding and to describe the characteristics of these deaths and the potential for prevention.


Histology reports for all deaths coded as NMSC (ICD-10 C44.0-C44.9) by the Western Australian Cancer Registry for the years 1996–2005 were reviewed for type of cancer, body site (primary tumor and metastases), and level of available documentation.


Of 368 deaths recorded as being due to NMSC only 3 were found to be miscoded. An additional 53 deaths contained inadequate information to confirm NMSC as the cause of death. Of the confirmed cases, 219 were due to squamous cell carcinoma, 53 to Merkel cell carcinomas, and 40 to other skin cancers. Cases were mainly males and were elderly. Most of the primary squamous and Merkel cell carcinomas were in areas of maximum sun exposure (face, ears, and hands, and scalp in males).


Misclassification of NMSC deaths in WA was minimal. The majority of NMSC deaths were due to squamous cell carcinomas; had primary sites associated with significant sun exposure; and occurred in older men.


Non-melanoma skin cancer Sun exposure Mortality Second cancer Squamous cell carcinoma Merkel cell carcinoma 



Lin Fritschi is supported by an Australian National Health and Medical Research Council Fellowship. We would like to thank the staff of the Western Australian Cancer Registry for considerable assistance in the identification and classification of cases.


  1. 1.
    Gallagher R, Lee T, Bajdik C (2007) Epidemiology of nonmelanocytic skin cancer. In: Ringborg U, Brandberg Y, Breitbart E, Greinert R (eds) Skin cancer prevention. Informa Healthcare USA, New York, pp 163–173Google Scholar
  2. 2.
    Australian Institute for Health and Welfare & Australasian Association of Cancer Registries (2007) Cancer in Australia: an overview 2007. AIHW, Canberra, Report No.: AIHW cat no. Can 32Google Scholar
  3. 3.
    Boniol M, Dore J, Autier P, Smans M, Boyle P (2007) Descriptive epidemiology of skin cancer incidence and mortality. In: Ringborg U, Brandberg Y, Breitbart E, Greinert R (eds) Skin cancer prevention. Informa Healthcare USA, New York, pp 203–219Google Scholar
  4. 4.
    Sober A, Haluska F (2001) Skin cancer. BC Decker, Hamilton, CanadaGoogle Scholar
  5. 5.
    Australian cancer network management of non-melanoma skin cancer working party (2003) Non-melanoma skin cancer: guidelines for treatment and management in Australia. National Health and Medical Research Council, CanberraGoogle Scholar
  6. 6.
    Staples M, Marks R, Giles G (1998) Trends in the incidence of non-melanocytic skin cancer (NMSC) treated in Australia 1985–1995: are primary prevention programs starting to have an effect? Int J Cancer 78(2):144–148PubMedCrossRefGoogle Scholar
  7. 7.
    McCarthy WH (2004) The Australian experience in sun protection and screening for melanoma. J Surg Oncol 86(4):236–245PubMedCrossRefGoogle Scholar
  8. 8.
    The Cancer Council Australia (2004) National cancer prevention policy 2004–2006. The Cancer Council Australia, NSWGoogle Scholar
  9. 9.
    Stanton WR, Janda M, Baade PD, Anderson P (2004) Primary prevention of skin cancer: a review of sun protection in Australia and internationally. Health Promot Int 19(3):369–378PubMedCrossRefGoogle Scholar
  10. 10.
    Halpern AC, Kopp LJ (2005) Awareness, knowledge and attitudes to non-melanoma skin cancer and actinic keratosis among the general public. Int J Dermatol 44(2):107–111PubMedCrossRefGoogle Scholar
  11. 11.
    Staples MM, Elwood M, Burton R, Williams J, Marks R, Giles G (2006) Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust 184(1):6–10PubMedGoogle Scholar
  12. 12.
    Australian Institute for Health and Welfare (2004) Cancer in Australia 2001. AIHW, Canberra. Report No.: cancer series no. 28Google Scholar
  13. 13.
    Green A, Williams G, Neale R et al (1999) Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet 354(9180):723–729PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenblatt LL, Marks RR (1996) Deaths due to squamous cell carcinoma in Australia: is there a case for a public health intervention? Australas J Dermatol 37(1):26–29PubMedCrossRefGoogle Scholar
  15. 15.
    Osterlind AA, Hjalgrim HH, Kulinsky BB, Frentz GG (1991) Skin cancer as a cause of death in Denmark. Br J Dermatol 125(6):580–582PubMedCrossRefGoogle Scholar
  16. 16.
    Weinstock MA, Bogaars HA, Ashley M, Litle V, Bilodeau E, Kimmel S (1992) Inaccuracies in certification of nonmelanoma skin cancer deaths. Am J Public Health 82(2):278–281PubMedCrossRefGoogle Scholar
  17. 17.
    Lewis K, Weinstock M (2004) Nonmelanoma skin cancer mortality (1988–2000): the Rhode Island follow-back study. Arch Dermatol 140(7):837–842PubMedCrossRefGoogle Scholar
  18. 18.
    Elwood M, Gallagher R (1998) Body site distribution of cutaneous malignant melanomas in relationship to patterns of sun exposure. Int J Cancer 78:276–280PubMedCrossRefGoogle Scholar
  19. 19.
    Database of Non-melanoma skin cancer (ICD-10 C44) Scotland: trends in mortality 1980-2006. [Internet] Scotland: General Register Office for Scotland; 2007 [cited 2007 March]. Available from
  20. 20.
    Threlfall T, Thompson J (2007) Cancer incidence and mortality in Western Australia, 2005. Western Australian Department of Health, Perth, Report No.: Statistical Series number 81Google Scholar
  21. 21.
    Schöllkopf C, Rosendahl D, Rostgaard K, Pipper C, Hjalgrim H (2007) Risk of second cancer after chronic lymphocytic leukemia. Int J Cancer 121(1):151–156PubMedCrossRefGoogle Scholar
  22. 22.
    Wiernik P (2004) Second neoplasms in patients with chronic lymphocytic leukemia. Curr Treat Options Oncol 5(3):215–223PubMedCrossRefGoogle Scholar
  23. 23.
    Travis L, Curtis R, Hankey B, Fraumeni J (1992) Second cancers in patients with chronic lymphocytic leukemia. J Natl Cancer Inst 84:1422–1477PubMedCrossRefGoogle Scholar
  24. 24.
    Hisada M, Biggar R, Greene M, Fraumeni JJ, Travis L (2001) Solid tumors after chronic lymphocytic leukemia. Blood 98(6):1979–1981PubMedCrossRefGoogle Scholar
  25. 25.
    Mellemgaard A, Geisler C, Storm H (1994) Risk of kidney cancer and other second solid malignancies in patients with chronic lymphocytic leukemia. Eur J Haematol 53(4):218–222PubMedCrossRefGoogle Scholar
  26. 26.
    Dong C, Hemminki K (2001) Second primary neoplasms among 53 159 haematolymphoproliferative malignancy patients in Sweden, 1958–1996: a search for common mechanisms. Br J Cancer 85(7):997–1005PubMedCrossRefGoogle Scholar
  27. 27.
    Levi F, Randimbison L, Te V, La Vecchai C (1996) Non-Hodgkins lymphomas, chronic lymphocytic leukaemias and skin cancers. Br J Cancer 74:1847–1850PubMedGoogle Scholar
  28. 28.
    Hartley B, Searle A, Breach N, Rhys-Evans P, Henk J (1996) Aggressive cutaneous squamous cell carcinoma of the head and neck in patients with chronic lymphocytic leukaemia. J Laryngol Otol 110(7):694–695PubMedCrossRefGoogle Scholar
  29. 29.
    Mehrany K, Weenig R, Lee K, Pittelkow M, Otley C (2005) Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia. J Am Acad Dermatol 53(6):1067–1071PubMedCrossRefGoogle Scholar
  30. 30.
    Robak T, Blonski J, Gora-Tybor J et al (2004) Second malignancies and Richter’s syndrome in patients with chronic lymphocytic leukaemia treated with cladribine. Eur J Cancer 40(3):383–389PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • J. Girschik
    • 1
  • Lin Fritschi
    • 1
  • T. Threlfall
    • 2
  • T. Slevin
    • 3
    • 4
  1. 1.Western Australian Institute for Medical ResearchNedlandsAustralia
  2. 2.Department of HealthWestern Australian Cancer RegistryEast PerthAustralia
  3. 3.The Cancer Council of Western AustraliaWest PerthAustralia
  4. 4.Centre for Behavioural Research in Cancer ControlCurtin University of TechnologyPerthAustralia

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