Importance Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult. Objective To estimate the incidence of NMSC (keratinocyte carcinomas) in the US population in 2012 and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the 2012 Medicare fee-for-service population. Design, Setting, and Participants This study analyzes US government administrative data including the Centers for Medicare & Medicaid Services Physicians Claims databases to calculate totals of skin cancer procedures performed for Medicare beneficiaries from 2006 through 2012 and related parameters. The population-based National Ambulatory Medical Care Survey database was used to estimate NMSC-related office visits for 2012. We combined these analyses to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population. Main Outcomes and Measures Incidence of NMSC in the US population in 2012 and BCC and SCC in the 2012 Medicare fee-for-service population. Results The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 13% from 2 048 517 in 2006 to 2 321 058 in 2012. The age-adjusted skin cancer procedure rate per 100 000 beneficiaries increased from 6075 in 2006 to 7320 in 2012. The number of procedures in Medicare beneficiaries specific for NMSC increased by 14% from 1 918 340 in 2006 to 2 191 100 in 2012. The number of persons with at least 1 procedure for NMSC increased by 14% (from 1 177 618 to 1 336 800) from 2006 through 2012. In the 2012 Medicare fee-for-service population, the age-adjusted procedure rate for BCC and SCC were 3280 and 3278 per 100 000 beneficiaries, respectively. The ratio of BCC to SCC treated in Medicare beneficiaries was 1.0. We estimate the total number of NMSCs in the US population in 2012 at 5 434 193 and the total number of persons in the United States treated for NMSC at 3 315 554. Conclusions and Relevance This study is a thorough nationwide estimate of the incidence of NMSC and provides evidence of continued increases in numbers of skin cancer diagnoses and affected patients in the United States. This study also demonstrates equal incidence rates for BCC and SCC in the Medicare population.

https://jamanetwork.com/journals/jamadermatology/articlepdf/2281227/doi150020.pdf

Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the US Population, 2012

Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Objectives To estimate the incidence of nonmelanoma skin cancer (NMSC) in the US population in 2006 and secondarily to indicate trends in numbers of procedures for skin cancer treatment. Design A descriptive analysis of population-based claims and US Census Bureau data combined with a population-based cross-sectional survey using multiple US government data sets, including the Centers for Medicare and Medicaid Services Fee-for-Service Physicians Claims databases, to calculate totals of skin cancer procedures performed for Medicare beneficiaries in 1992 and from 1996 to 2006 and related parameters. The National Ambulatory Medical Care Service database was used to estimate NMSC-related office visits. We combined these to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population. Results The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 76.9% from 1 158 298 in 1992 to 2 048 517 in 2006. The age-adjusted procedure rate per year per 100 000 beneficiaries increased from 3514 in 1992 to 6075 in 2006. From 2002 to 2006 (the years for which the databases allow procedure linkage to patient demographics and diagnoses), the number of procedures for NMSC in the Medicare population increased by 16.0%. In this period, the number of procedures per affected patient increased by 1.5%, and the number of persons with at least 1 procedure increased by 14.3%. We estimate the total number of NMSCs in the US population in 2006 at 3 507 693 and the total number of persons in the United States treated for NMSC at 2 152 500. Conclusions The number of skin cancers in Medicare beneficiaries increased dramatically over the years 1992 to 2006, due mainly to an increase in the number of affected individuals. Using nationally representative databases, we provide evidence of much higher overall totals of skin cancer diagnoses and patients in the US population than previous estimates. These data give the most complete evaluation to date of the underrecognized epidemic of skin cancer in the United States.

https://jamanetwork.com/journals/jamadermatology/articlepdf/209782/dst90063_283_287.pdf

Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006

Basal cell carcinomas (BCCs) were essentially a molecular 'black box' until some 12 years ago, when identification of a genetic flaw in a rare subset of patients who have a great propensity to develop BCCs pointed to aberrant Hedgehog signalling as the pivotal defect leading to formation of these tumours. This discovery has facilitated a remarkable increase in our understanding of BCC carcinogenesis and has highlighted the carcinogenic role of this developmental pathway when aberrantly activated in adulthood. Importantly, a phase 1 first-in-human trial of a Hedgehog inhibitor has shown real progress in halting and even reversing the growth of these tumours.

/pdf/basal-cell-carcinomas-attack-of-the-hedgehog-4wxo5xy87f.pdf

Basal cell carcinomas: attack of the hedgehog

Cutaneous squamous cell carcinoma.

ContextThe incidence of nonmelanoma skin cancer is increasing rapidly among
elderly persons, but little is known about its incidence in the population
younger than 40 years.ObjectivesTo estimate the sex- and age-specific incidences of basal cell carcinoma
and squamous cell carcinoma in persons younger than 40 years in Olmsted County,
Minnesota, and to evaluate change in incidence over time; to describe the
clinical presentation, rate of recurrence and metastasis, and histologic characteristics
of these tumors in this population-based sample.DesignPopulation-based retrospective incidence case review.SettingResidents of Olmsted County, Minnesota, a population with comprehensive
medical records captured through the Rochester Epidemiology Project.ParticipantsPatients younger than 40 years with basal cell carcinoma or squamous
cell carcinoma diagnosed between 1976 and 2003.Main Outcome MeasuresIncident basal cell carcinomas and squamous cell carcinomas and change
in incidence of these tumors over time.ResultsDuring the study period, 451 incident basal cell carcinomas were diagnosed
in 417 patients and 70 incident squamous cell carcinomas were diagnosed in
68 patients. Of these tumors, 328 were histologically confirmed basal cell
carcinomas and 51 were histologically confirmed squamous cell carcinomas.
Overall, the age-adjusted incidence of basal cell carcinoma per 100 000
persons was 25.9 (95% confidence interval [CI], 22.6-29.2) for women and 20.9
(95% CI, 17.8-23.9) for men. The incidence of basal cell carcinoma increased
significantly during the study period among women (P<.001)
but not men (P = .19). Nodular basal cell
carcinoma was the most common histologic subtype; 43.0% of tumors were solely
nodular basal cell carcinoma and 11.0% had a mixed composition, including
the nodular subtype. The incidence of squamous cell carcinoma was similar
in men and women, with an average age- and sex-adjusted incidence per 100 000
persons of 3.9 (95% CI, 3.0-4.8); the incidence of squamous cell carcinoma
increased significantly over the study period among both women (P = .01) and men (P = .04).ConclusionsThis population-based study demonstrated an increase in the incidence
of nonmelanoma skin cancer among young women and men residing in Olmsted County,
Minnesota. There was a disproportionate increase in basal cell carcinoma in
young women. This increase may lead to an exponential increase in the overall
occurrence of nonmelanoma skin cancers over time as this population ages,
which emphasizes the need to focus on skin cancer prevention in young adults.

/pdf/incidence-of-basal-cell-and-squamous-cell-carcinomas-in-a-5ctusos6ro.pdf

Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years.

We report a unique case of a 69-year-old man who presented with a 1-year history of pink nodules and plaques limited to the anterior plantar surface of the right foot and a 30-year history of a callus on the right heel. Histologic examination findings of both areas showed deposits of amorphous, eosinophilic material and an infiltrate of plasma cells in the dermis. Congo red–stained deposits exhibited apple-green birefringence with polarized light. Results of an extensive clinical and laboratory evaluation showed no evidence of systemic amyloidosis. The diagnosis of nodular primary localized cutaneous amyloidosis (PLCA) was made. Nodular PLCA isolated to pedal or strictly plantar surfaces is an unusual presentation of PLCA. The origin and the clinical and histopathologic features of nodular PLCA are reviewed.

https://www.jaad.org/article/S0190-9622(03)00433-X/pdf

Theresa A. Borrowman

Papers

Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years.

Cutaneous nodular amyloidosis masquerading as a foot callus