Skin cancer incidence and mortality
Skin cancer in Australia
Table 1 shows the latest national incidence count of melanoma, as provided by the Australian Institute of Health and Welfare (AIHW), and the number of paid Medicare services for non-melanoma skin cancers (NMSC: basal cell carcinoma, squamous cell carcinoma) based on Medicare records. The latest mortality statistics for melanoma and NMSC are provided as reported by the Australian Bureau of Statistics (ABS) for 2019.
According to the latest ABS data, of the Australians living with cancer in 2017-18, nearly one in three (30.8%) had skin cancer, making this the most common type of cancer. Medicare records show there are over 950,000 paid Medicare services for non melanoma skin cancers each year – more than 2,500 treatments each day.
At least 2 in 3 Australians will be diagnosed with skin cancer before the age of 70. The risk is higher in men than in women (70% vs. 58% cumulative risk of NMSC before age 70; 65 vs. 43 age-standardised incidence rate of melanoma). The risk of mortality is also higher for men - 67% of Australians who die from skin cancer are men.
Skin cancer causes more deaths than transport accidents every year in Australia.
Table 1 Australian incidence and mortality for non-melanoma skin cancer (NMSC) and melanoma
|NMSC (number of paid Medicare services, not people*) 2014||600,482||358,761||959,243|
NMSC mortality includes deaths from the common skin cancers (SCC & BCC) and deaths from the rarer variants like Merkel cell tumours, dermatofibroma protuberans, and others.
AIHW data shows a recent decline in melanoma mortality rates (Figure 1). There has also been a recent decline in the age-specific incidence rates for melanoma among those under the age of 40 years,  and a significant decline in excision rates of non-melanoma skin cancer among those aged under 45 years. This follows earlier observations of stable incidence trends among young people in Australia, who are likely to have reduced their UV radiation exposure as a consequence of long-running public education campaigns to improve sun protection. A similar pattern has been observed for several other high-risk countries including New Zealand, North America, Israel and Norway. These recent changes illustrate the importance of decreased UV exposure in childhood as a key contributor in lowering skin cancer risk later in life.
Figure 1 Mortality rates in Australia 1982 to 2018.
Melanoma incidence and mortality
Melanoma of the skin is the third most commonly diagnosed cancer in in Australia (excluding NMSC). In 2016,14,485 new cases of melanoma were diagnosed in Australia, and in 2019, 1,415 people died.
Table 2 Australian incidence and mortality of melanoma
The rates were age-standardised to the Australian population as at 30 June 2001, and are expressed per 100,000 population
In Australia, the age-standardised incidence rate for melanoma increased by 100% between 1982 and 2016, from 26.7 cases per 100,000 persons to 53.5 cases per 100,000 persons,. However, how much of this increase is due to a real increase in the underlying disease, and how much is due to improved detection methods, is unknown. The incidence of melanoma of the skin rose at around 5.0% per year during the 1980s, moderating to 2.8% per year after that up until 2010. It is predicted that the initial rapid increase is partly attributable to individual behaviour and the use of solariums, resulting in increased exposure to solar ultraviolet radiation. The moderated trend seen after the 1980s is consistent with increased awareness of skin cancer and improved sun protective behaviours as a result of extensive skin cancer prevention programs dating back to the 1980s.
In 2019, Australian women were estimated to have a 1 in 21 chance of being diagnosed with melanoma before the age of 85, whereas men were estimated to have a 1 in 14 risk.
As noted above, the age-standardised incidence rate of melanoma increased by 100% between 1982 and 2016, from 26.7 per 100,000 persons to 53.5 per 100,000 persons. This increase was more marked for men than women. For men the age-standardised rate increased by 133% from 27.9 to 65.1 cases per 100,000 men, while for women the increase is 65%, from 26.3 to 43.5 cases per 100,000 women.
Gender differences are also observable in relation to mortality. Overall, in 2016 Australians had a 1 in 168 chance of dying from melanoma by age 85 – men had a 1 in 114 chance and women had a 1 in 287 chance.
Death rates for melanoma among men increased from 6.4 deaths per 100,000 in 1982 to a peak of 9.6 deaths per 100,000 in 2011, before declining to 7.0 deaths per 100,000 in 2018. For women, rates increased from 3.2 deaths per 100,000 in 1982 to a peak of 3.9 deaths per 100,000 in 2006, before declining to 2.9 per 100,000 in 2018. The estimated death rate for men and women in 2020 was 6.1 and 2.8 per 100,000 respectively. 
There is an observable age gradient for melanoma incidence according to AIHW data:
- 9.2% of people diagnosed with melanoma are aged under 40 years;
- 11.2% are aged 40-49;
- 18.4% are aged 50-59;
- 24.4% are aged 60-69;
- 20.4% are aged 70-79; and
- 16.3% are aged 80 or older.
The mean age for melanoma diagnosis is 63 years among men and 60 years among women.
While only a small proportion of total melanoma cases are diagnosed in people under 35 years of age, Australian adolescents have by far the highest incidence of malignant melanoma in the world compared with adolescents in other countries. Furthermore, melanoma is the most common cancer diagnosed in young Australians aged 15-24 years, accounting for 15% of all cancers in this age group. However, research in Queensland suggests a decline in the incidence of thin invasive melanoma since the mid- to late 1990s among young people who have been exposed to Queensland’s primary prevention and early detection programs since birth. Nationally, age-standardised incidence rates for melanoma fell from 96 new cases per 1 million young Australians in 1985–1989 to 44 new cases per 1 million in 2010–2014.
Australia’s high incidence of skin cancer is attributable to a combination of its predominantly fair-skinned population and high levels of ambient UV radiation due to proximity to the equator.
According to 2018 IARC data, Australia has the highest age-standardised melanoma incidence rate (33.6 per 100,000, standardised to World Population) and mortality rate (3.2 per 100,000) of melanoma in the world. Melanoma incidence rates in Australia and New Zealand are more than two to three times higher than those in Canada, the United States and the United Kingdom. Although mortality rates are quite low, they are still more than two times higher in Australia and New Zealand than in Canada, the United States, and the United Kingdom.
Within Australia, people in Queensland face the highest risk of developing melanoma, followed by Western Australia, New South Wales, Tasmania, Australian Capital Territory, Victoria, South Australia, and Northern Territory.
Melanoma incidence rates in regional and remote areas are higher than in major cities. During the period 2010–2014, those living in Inner regional areas of Australia had higher age-standardised incidence rates for melanoma than people living in Very remote areas. Particularly high mortality rates have been observed for those living in inner or outer regional areas.
In Australia, there is no clear association of melanoma with socioeconomic status. The mortality rate is highest in the second and third lowest socioeconomic groups, and lowest in the highest socioeconomic group.
In 2010-2014, there were annual averages of 38 melanoma cases for male Indigenous Australians, and 28 cases for female Indigenous Australians. In 2012-16, there were averages of 3 and 2 deaths per year for male Indigenous Australians and female Indigenous Australians, respectively..
In 2005–2009, data from New South Wales, Queensland, Western Australia and the Northern Territory shows that the incidence of melanoma was 9.3 cases per 100,000 among Indigenous Australians, compared with 33 cases per 100,000 among non-Indigenous Australians. Mortality rates were also lower for Indigenous Australians (2.3 deaths per 100,000) compared with non-Indigenous Australians (6.4 deaths per 100,000).
Non-melanoma incidence and mortality
Although NMSC is the most common cancer type in Australia, it is often reported that breast cancer is the most common cancer in women and prostate cancer is the most common in men. That’s because most Australian cancer registries don’t routinely collect data for these more common forms of skin cancer – only the most serious, melanoma. NMSC are often self-detected and are usually removed in doctors’ surgeries, sometimes without histological confirmation due to destructive treatment techniques, or treatment with topical creams where tumour sites are only excised in post-treatment testing.
As the latest incidence data is estimated from self-reported, histologically confirmed (81.5%) and unconfirmed, NMSC treated in 2002, Medicare service numbers are provided as a proxy measure below.
Table 3: Australian incidence and mortality of Non-Melanoma Skin Cancers
|Incidence||2014 (number of paid Medicare services, not people*)||600,482||358,761||959,243|
|Incidence per 100,000||2002 (estimated from survey)||1,531||1,036||1,271|
NMSC mortality includes deaths from the common skin cancers (SCC & BCC) and deaths from the rarer NMSCs like Merkel cell tumours, dermatofibroma protuberans etc.
NMSC accounted for 959,243 paid Medicare services in 2014 as evaluated from data on NMSC excisions, curettage, laser, or liquid nitrogen cryotherapy treatments.
Findings from the annual BEACH surveys of general practice conducted from 2006 to 2016 showed that skin cancer predominated as the cancer most often managed (by way of medications, clinical and procedural treatments, ordering of pathology or imaging tests) in GP-patient encounters, and was consistently among the top ten conditions managed by GPs.
Despite the high incidence rate of NMSC, the age-standardised mortality rates are relatively low at 3.2 deaths per 100,000 population for males and 1.1 deaths per 100,000 for females.
Skin cancer is estimated to have cost the Australian Health System $1.1659 billion (including diagnosis, treatment and pathology) in 2015/16. $1.005.1 billion of this was attributed to NMSC and $160.8 million was attributed to melanoma.
In the same year, $607 million of NMSC expenditure and $144.7 million of melanoma expenditure was attributed to high sun exposure.
In Australia, relative survival after diagnosis of melanoma of the skin is very high when compared with other types of cancer. The 5-year relative melanoma survival rate increased from 88% in the period 1986-1990 to 91% in 2011-2015
In the period 2011-2015:
- Five-year relative survival for melanoma was greater for women compared with men (94% compared with 89%).
- Five-year relative survival for NMSC was greater for women compared with men (77% compared with 67%)
- Survival was high for all age groups, gradually declining with age (95% or higher 5-year survival for those below 40 years as compared with 83% for those aged 75 years and over).
In 2011, although survival was high overall it varied considerably by stage at diagnosis. Five-year relative survival was almost 100% for melanoma diagnosed at Stage 1, but only 26% when diagnosed at Stage IV.
Australian survival rates from melanoma are generally higher than in other countries due to the high proportion of thin lesions, according to the Cancer Epidemiology Centre at Cancer Council Victoria. Survival rates are higher in countries where there is greater melanoma awareness due to earlier detection.
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