Abstract
Background
The occurrence of keratinocyte carcinomas (KC) worldwide appears to be increasing, however, information on the actual incidence of these tumours is often incomplete.
Objectives
The aim of this study was to provide information on the KC/melanoma ratio in order to indirectly estimate the occurrence of KC.
Materials & Methods
Data were collected according to a snowball sampling procedure between Italian dermatologists. Colleagues working on melanoma and non-melanoma units were excluded. These ratios were applied to estimates derived from histopathological records, namely melanoma incidence estimates available from the Italian National Cancer Registry Network. The final estimates for KC incidence were thus obtained using the formula: KC incidence (per 100,000) = melanoma incidence (per 100,000) * (KC/melanoma ratio).
Results
Our results revealed a BCC/melanoma ratio of 4.4 and SCC/melanoma ratio of 1.7; values that are approximately 4 to 5 times smaller than those self-reported by dermatologists. Interestingly, this large discrepancy was not observed for the BCC/SCC ratio, which was 2.5 in the north, 2.7 in the centre, and 3.2 in the south of Italy, with an overall value of 2.8. Based on the histopathological data, this ratio was 2.6.
Conclusion
In Italy, the actual occurrence of BCC and SCC seems to be vastly underestimated based on histopathological data, compared to data reported by dermatologists.
References
Jackson R, Finkelstein H. Historical aspects of nonmelanoma skin cancer. Clin Dermatol 1995; 13: 517–25.
Karimkhani C, Boyers LN, Dellavalle RP, Weinstock MA. It’s time for “keratinocyte carcinoma” to replace the term “nonmelanoma skin cancer”. J Am Acad Dermatol 2015; 72: 186–7.
Diepgen TL, Mahler V. The epidemiology of skin cancer. Br J Dermatol 2002; 146: 1–6.
Nagarajan P, Asgari MM, Green AC, et al. Keratinocyte carcinomas: current concepts and future research priorities. Clin Cancer Res 2019; 25: 2379–91.
Zink A, Wurstbauer D, Rotter M, Wildner M, Biedermann T. Do outdoor workers know their risk of NMSC? Perceptions, beliefs and preventive behaviour among farmers, roofers and gardeners. J Eur Acad Dermatol Venereol 2017; 31: 1649–54.
Parker ER. The influence of climate change on skin cancer incidence–A review of the evidence. Int J Women’s Dermatol 2021; 7: 17–27.
Gilchrest BA, Eller MS, Geller AC, Yaar M. The pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med 1999; 340: 1341–8.
Leiter U, Eigentler T, Garbe C. Epidemiology of Skin Cancer. In: Reichrath J, ed. Sunlight, Vitamin D and Skin Cancer. New York, NY: Springer New York, 2014: p. 120–40.
Neri L, Peris K, Longo C, et al. Physician–patient communication and patient-reported outcomes in the actinic keratosis treatment adherence initiative (AK-TRAIN): a multicenter, prospective, real-life study of treatment satisfaction, quality of life and adherence to topical field- directed therapy for the treatment of actinic keratosis in Italy. J Eur Acad Dermatol Venereol 2019; 33: 93–107.
Kus KJB, Ruiz ES. Non-surgical treatments for keratinocyte carcinomas. Adv Ther 2021; 38: 5635–48.
Wehner MR, Cidre Serrano W, Nosrati A, et al. All-cause mortality in patients with basal and squamous cell carcinoma: a systematic review and meta-analysis. J Am Acad Dermatol 2018; 78: 663–72.e3.
Nehal KS, Bichakjian CK. Update on keratinocyte carcinomas. N Engl J Med 2018; 379: 363–74.
Fania L, Ricci F, Sampogna F, et al. Prevalence and incidence of hidradenitis suppurativa: an exercise on indirect estimation from psoriasis data. J Eur Acad Dermatol Venereol 2017; 31: e410–e1.
Fania L, Samela T, Moretta G, et al. Attitudes among dermatologists regarding non-melanomaskin cancer treatment options. Discov Oncol 2021; 12: 31.
Goodman LA. Snowball sampling. Ann Math Stat 1961; 32: 148–70, 23.
Tukey JW. Exploratory Data Analysis. Addison-Wesley Publishing Company, 1977.
Gori S, Alavilla G, Ascierto P, et al. I NUMERI DEL CANCRO IN ITALIA 2020: Fondazione AIOM2020.
Lucke TW, Hole DJ, Mackie RM. An audit of the completeness of non-melanoma skin cancer registration in Greater Glasgow. Br J Dermatol 1997; 137: 761–3.
McLoone NM, Middleton RJ, Gavin AT, Walsh M, Dolan OM. Audit of basal cell carcinoma: registration practice. Br J Dermatol 2003; 148: 371.
Goodwin RG, Holme SA, Roberts DL. Variations in registration of skin cancer in the United Kingdom. Clin Exp Dermatol 2004; 29: 328–30.
Carlos Anselmo L, Marcela Sampaio L, Angela Maria Da S, et al. Do cancer registries play arole in determining the incidence of non-melanoma skin cancers? Eur J Dermatol 2018; 28: 169–76.
Crispo A, Corradin MT, Giulioni E, et al. Real life clinical management and survival in advanced cutaneous melanoma: the italian clinical national melanoma registry experience. Front Oncol [Original Research] 2021; 11.
Sacchetto L, Rosso S, Comber H, et al. Skin melanoma deaths within 1 or 3 years from diagnosis in Europe. Int J Cancer 2021; 148: 2898–905.
Apalla Z, Nashan D, Weller RB, Castellsagué X. Skin cancer: epidemiology, disease burden, pathophysiology, diagnosis, and therapeutic approaches. Dermato Ther 2017; 7: 5–19.
Perera E, Gnaneswaran N, Staines C, Win AK, Sinclair R. Incidence and prevalence of non- melanoma skin cancer in Australia: a systematic review. Austr J Dermatol 2015; 56: 258–67.
Naldi L, Chatenoud L, Piccitto R, Colombo P, Placchesi EB, La Vecchia C. Prevalence of actinic keratoses and associated factors in a representative sample of the italian adult population: results from the prevalence of actinic keratoses italian study, 2003–2004. Arch Dermatol 2006; 142: 722–6.
Chahal HS, Rieger KE, Sarin KY. Incidence ratio of basal cell carcinoma to squamous cell carcinoma equalizes with age. J Am Acad Dermatol 2017; 7: 353- 4.
Jiyad Z, Marquart L, Green AC. A call to standardize the BCC: SCC ratio. Br J Dermatol 2021; 184: 545.
Acknowledgments
we thank the colleagues of the Italian Association of Hospital Dermatologists (ADOI) who made this study possible.
Funding
Financial support: all authors were partially supported by the “Progetto Ricerca Corrente - 2021” of the Italian Ministry of Health, Rome, Italy.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests: none.
About this article
Cite this article
Samela, T., Fania, L., Sampogna, F. et al. Incidence of keratinocyte carcinomas in Italy: an exercise in indirect estimation based on melanoma data. Eur J Dermatol 33, 230–234 (2023). https://doi.org/10.1684/ejd.2023.4476
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1684/ejd.2023.4476