NEW ORLEANS—More than 3.7 million cases of non-melanoma skin cancer were treated in the United States in 2009, the most recent year when full statistical data were available, and researchers here at the American Academy of Dermatology Annual Meeting estimated that that number will double in 15-20 years.
“We are in the midst of an epidemic of non-melanoma skin cancer,” said Brett M. Coldiron, MD, Clinical Associate Professor of Dermatology at the University of Cincinnati. He calculated that in 2009 the number of skin cancer cases increased by 1.6% over 2008, for a total of 3,743,315 cases. That is about 250,000 more than Dr. Coldiron and colleagues reported last year, based on data through 2006.
“What we are reporting at this meeting is new data that shows the trend is continuing upward,” he said. “This is a heavy burden of disease. I suspect this epidemic will only accelerate as suntanned baby boomers age. “Considering this epidemic, it is most prudent and cost effective to focus on prevention through sunscreen use, restriction of tanning parlors, education, and research.”
Trying to pinpoint the number of these cancers has not been easy, Dr. Coldiron said at a news conference. “We looked to the left and looked to the right and said, ‘We've got an epidemic of skin cancer.’ But I've been told that I can't say that because I have no numbers. So I thought about it, and figured out a way to calculate the numbers of skin cancers.”
No National Database
The heart of the problem, he explained, “is that non-melanoma skin cancer is a non-reported disease. There is no national varied services and locations, but a nonmelanoma skin cancer cannot be treated database for non-melanoma skin cancer, no available database from national private insurers. There is no place to get easy numbers.”
Dr. Coldiron noted that treatment of non-melanoma skin cancer is provided by many specialties in varied services and locations, but a nonmelanoma skin cancer cannot be treated wiithout a positive biopsy, which is required for reimbursement. The number of procedures for non-melanoma skin cancer is available, so the number of procedures for non-melanoma skin cancer is an excellent proxy for actual number of non-melanoma skin cancer.”
He did note that the figures might underestimate the number of skin cancer cases because the database would not capture skin cancer treatments that use topical agents.
Dr. Coldiron gathered information on treatment of non-melanoma skin cancer, scrutinizing records for the Medicare physician/supplier procedure summary master file; the Medicare Limited Data Set Standard Analytic File 5% Sample Physician Supplier Data for the years 2002-2009, and the National Ambulatory Medical Care Survey.
He estimated that the number of procedures equals the total number of approved malignant destructions, malignant excisions, and Mohs micrographic surgeries. The total specific to non-melanoma skin cancer ratio was determined by multiplying 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 non-melanoma cutaneous malignancy and in situ malignancy.
The number of procedures per affected individual and the number of unique persons undergoing at least one procedure for non-melanoma skin cancer were derived from the 5% Sample Data Set.
He extrapolated Medicare findings to the rest of the American public. “The ratio of office visits for a diagnosis of non-melanoma skin cancer to the number of procedures for non-melanoma skin cancer as defined by the non-melanoma skin cancer is approximately the same in those over and under 65 years of age,” he explained.
The results showed that the number of skin cancers in the Medicare population has increased by an average of 4.2% per year from 1992 to 2006. The number of nonmelanoma skin cancer cases increased an additional 2.6% per year from 2006 to 2008, and an additional 1.6% in 2009, providing the present figure of more than 3.74 million cases. “This is certainly a concern,” Dr. Coldiron said.
While the rate of increase jumps around—5.4% in 2004-2005 compared with 2003; 2% in 2005-2006; 2.4% in 2006-2007; 2.6% in 2007-2008, and 1.6% in 2008-2009—overall it looks like it may be slowing down.”
If you figure than an initial visit to the doctor to evaluate a skin lesions costs about $125 and the cost of a skin biopsy is $95 and the cost of skin pathology is $125, and the cost of a procedure is $2000, then the financial burden of non-melanoma skin cancer in the US is about $8,639,838,270, he said.
“That tab doesn't include topical, and it doesn't include in the calculation that private insurers tend to pay more than Medicare. My cost estimates are based on Medicare reimbursements, which tend to be lower than private insurers.
“These data give the most complete evaluation to date of the under-recognized epidemic of skin cancer in the United States. Non-melanoma skin cancer is more than triple the last published estimate from 1994. At this rate of increase, the total number of non-melanoma skin cancer will double every 15 to 20 years.”
‘As People Are Aging, the Situation Is Getting Worse’
“We are dealing with what happened years ago,” said Darrell S. Rigel, MD, Clinical Professor of Dermatology at New York University Medical Center and a former President of the American Academy of Dermatology. “We didn't have good sunscreens when the baby boomers were going to the beach and were working and playing outside. As people are aging, the situation is getting worse.”
Dr. Coldiron suggested, however, that national funding to care for skin cancer patients is not keeping pace with the epidemic. “In the face of this epidemic, continued national research and programs on treatment, education, and prevention are critical,” he said.
“We must admit there is an epidemic. I don't think that Congress or the policy wonks have any idea there is an epidemic. If they do realize it, they are looking the other way, because there is no new money going into the Medicare pool. There is no mechanism in the Medicare calculation for dealing with an epidemic. We must alert policymakers. We must allocate additional money for treatment of skin cancer and training of personnel.
“I think this is a problem,” said Dr. Coldiron who funded the study through his own resources that did not include industry or governmental support. “We need to disseminate this information.”