Skin

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

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
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
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

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
age, males, Great Britain, 1975-2010.1-3
1990
-1992
1995
-1997
2000
-2002
2005 2008
-2007 -2010
Year of diagnosis
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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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

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
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
Cancer
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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

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
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

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
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

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

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.
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
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
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

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).
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
Cancer
Statistics
Statistics
REPORT
REPORT
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

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

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
Portugal
Romania
Rate per 100,000

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

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
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
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

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
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
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

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
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
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Statistics
Statistics
REPORT
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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

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
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
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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
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

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
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
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Statistics
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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
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

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
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

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).
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In Europe and
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on request, April 2012. Similar data can
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Cancer Intelligence and Surveillance Unit
on request, April 2012. Similar data can
be found here: http://www.wales.nhs.uk/
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4.5
4. Data were provided by the Northern

Ireland Cancer Registry on request, June
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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

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
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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

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
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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.
stats.team@cancer.org.uk
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SKIN CANCER

One-, fiveand ten-year

There are two types of skin cancer: malignant melanoma of

Malignant melanoma is a cancer that develops from

NCIN lead cancer registration

SunSmart, the UK's national

Malignant melanoma is the fifth most common cancer in the

Table 1: Malignant Melanoma Incidence by Country

There are several different types of NMSC: basal cell carcinoma

Called malignant melanoma hereafter.

Malignant melanoma (C43)

Wales Scotland Northern

Number of new cases1-4

Statistics on sunbed use

2.1 By country in the UK

Crude rate per 100,0001-4

European age-standardised rate per 100,0001-4

One-, fiveand ten-year

The crude incidence rateb shows that there are 20 new

2.3 Trends over time

Figure 2: Malignant Melanoma Incidence Over Time,

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

Age-specific incidence rates increase steadily from around age

Figure 1: Malignant Melanoma Incidence by Age

Some of the increase may be due to increased surveillance

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

Crude rates are calculated using a simple formula in which the

Malignant melanoma incidence trends for the UK are shown

Figure 3: Malignant Melanoma Incidence Over Time,

Figure 5: Malignant Melanoma Incidence Over Time

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

Malignant melanoma incidence rates have increased overall for

Malignant melanoma incidence rates in males and females

Figure 4: Malignant Melanoma Incidence Over Time

Figure 6: Malignant Melanoma Incidence Over Time

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

One-, fiveand ten-year

Rate per 100,000

Malignant melanoma incidence rates have also increased

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

2.4 Lifetime risk

The lifetime risk for malignant melanoma has been calculated

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

Table 2: Malignant Melanoma Cases by Stage

Figure 7 shows the percentage distribution of malignant

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

Figure 7: Malignant Melanoma Cases by Body Site

One-, fiveand ten-year

Stage not known

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

A study using data from three English cancer registries for

2.7 In Europe and worldwide

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

Head & neck

2.5 Distribution of cases

Although cancer registration has a long history in many

2.6 By stage at diagnosis

Malignant melanoma is the 19th most common cancer

One-, fiveand ten-year

Figure 8: Malignant Melanoma Incidence Worldwide

Figure 9: Malignant Melanoma Incidence in Europe

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

Rate per 100,000

UK malignant melanoma incidence rates are estimated

An absolute change in survival is the numerical difference when one