Trends in keratinocyte cancers in England, 2013-2022: basal cell carcinoma incidence, cutaneous squamous cell carcinoma incidence, and non-melanoma skin cancer mortality.

Abstract

Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC), collectively termed keratinocyte cancers (KCs), are the most common cancers in White populations, and their incidence is increasing globally. KCs are substantially underreported, and high-quality long-term data on patient demographics, incidence, and mortality trends remain limited. To describe the characteristics of patients with KCs and to assess incidence and mortality trends in England between 2013 and 2022. We analysed all new KCs diagnosed in England from 2013 to 2022 using data from the National Disease Registration Service. Tumours were counted using per patient per annum (PPPA) methodology, whereby each individual could contribute one BCC and one CSCC per year. Age-standardised incidence rates (EASRs) and age-standardised mortality rates (ASMRs) were calculated using the 2013 European Standard Population, while age-specific incidence rates (ASIRs) were calculated using Office for National Statistics mid-year population estimates for the corresponding age group. Joinpoint regression was used to calculate annual percentage change (APC) and assess trends in EASRs, ASIRs, and ASMRs by gender and age per 100,000 person-years (PYs). Compared with the first-all-time registration method, the PPPA approach identified 67% more BCCs and 42% more CSCCs over the study period. In 2022, PPPA EASRs were 295 PYs for BCC and 102 PYs for CSCC. BCC EASRs increased initially before stabilising from 2015 (APC -0.2% (95% CI -0.8-0.3)). In contrast, CSCC EASRs increased rapidly from 2013 to 2015 (from 79 to 89; APC 6.1%) and continued to increase between 2015 and 2019 (from 89 to 97; APC 2.3%). NMSC ASMR increased significantly from 2013 (APC 4.0% (95% CI. 2.5-5.7)), with rates rising approximately twice as fast in males (APC 4.4% (95% CI 2.4-7.1)) compared to females (APC 2.2 (95% CI 0.3-4.6)). For CSCC, ASIRs plateaued in middle age groups from 2015 onwards but continued to increase in younger (<60 years) and older (≥80 years) individuals. These findings highlight the importance of accurate tumour counting methods for healthcare planning. CSCC incidence continues to rise alongside increasing NMSC mortality, underscoring the need for strengthened prevention strategies, early diagnosis, and timely access to quality healthcare.