NEW ORLEANS – There were approximately 3.7 million nonmelanoma skin cancers in the United States in 2009, up almost 2% from the previous year, said Dr. Brett Coldiron.
This number marks the continuation of an upward trend in the incidence of skin cancer, noted Dr. Coldiron, a private practice dermatologic surgeon and member of the dermatology faculty at the University of Cincinnati. He presented his preliminary 2009 data at the American Academy of Dermatology's annual meeting and noted that the vast numbers of those affected seem to indicate an epidemic.
"At this rate of increase, the total number of nonmelanoma skin cancer [NMSC] will double every 15-20 years," said Dr. Coldiron.
The data update a study he and his colleagues published last year estimating that there were 3.5 million NMSCs, affecting 2.1 million people in the United States in 2006 (Arch. Dermatol. 2010;146:283-7). He and his colleagues estimated that the number of skin cancer procedures increased by 77% from 1992 to 2006. During this time, there was a 16% increase in procedures for NMSCs in the Medicare population.
NMSC is not a reportable disease, so there have not been good estimates for how many Americans are affected. For his initial paper, said Dr. Coldiron, "It occurred to me one day that you can’t treat NMSC without a positive pathologic diagnosis, or they’ll send you off to jail."
So he sought procedure data from Medicare’s Fee-for-Service Physicians Claims database and the National Ambulatory Medical Care Survey database. Procedures are "a pretty good proxy for the actual number of NMSCs," said Dr. Coldiron.
To get a total number of NMSCs, he and his colleagues multiplied the estimated crude number of skin cancers by the proportion of skin cancer procedure code claims associated with the ICD-9-CM diagnoses for invasive nonmelanoma cutaneous malignancy (173.0-173.9) and in situ malignancy (232.0-232.9).
Looking at trends, it appears the number of procedures have been leveling off at about a 2% rate the last few years, said Dr. Coldiron. However, the continued increase should be of concern to physicians, patients, and policy makers, he said.
The cost of treating NMSCs is around $8 billion a year, "so it’s serious money," he said.
In commenting on Dr. Coldiron’s findings, Dr. Darrell S. Rigel, who is a professor of dermatology and dermatologic surgery at New York University Medical Center, said that the number of NMSCs is "surprisingly high." Overall, skin cancer is much more common than all other cancers combined, said Dr. Rigel, adding that he had conducted studies showing that the lifetime risk of developing melanoma—invasive and in situ—now stood at 1 in 35 in the United States.
And, more than 10,000 Americans will die from skin cancer this year. "So it is a serious public health problem," said Dr. Rigel.
For his part, Dr. Coldiron said, "We have to convince people there is an epidemic out there." In addition to increasing Medicare funding to treat NMSCs, "it’s prudent and cost effective to focus on prevention," he said.
Dr. Coldiron reported no conflicts related to his talk. His study was self-funded.