Skin cancer - UK incidence statistics

Malignant melanomas are the least common but most serious type of skin cancer, with 11,767 new cases diagnosed in 2008. 1-4 Melanomas can occur in other body organs, e.g. the eye. In this section, only cutaneous melanomas (ICD10 C43) are discussed.

It has been estimated that the lifetime risk of developing malignant melanoma in 2008 is 1 in 61 for men and 1 in 60 for women in the UK. This was done using the AMP method 13

Figure 1.1 depicts the percentage distribution of malignant melanoma on parts of the body (percentages may not add due to rounding).These vary by sex, with over a third of male cases arising on the trunk of the body, particularly the back; while the most common site for females is on the legs.5

Figure 1.1: Malignant Melanoma (C43), Percentage Distribution of Cases Diagnosed on Parts of the Body, by Sex, Great Britain, 2006-2008

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The latest statistics show that 6,183 cases of malignant melanoma were diagnosed in women and 5,584 in men in the UK in 2008. 1-4 The numbers and rates for the constituent countries of the UK are shown in Table 1.1. 1-4

Table 1.1: Malignant Melanoma (C43), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2008

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*95% LCL and 95% UCL are the 95% lower and upper confidence limits around the AS Rate

Unlike most malignancies, malignant melanoma is more common in women than men. In 2008 it was the sixth most common cancer in females. Between 2007 and 2008 malignant melanoma moved from the ninth most common cancer  in males to the sixth most common. This is due to an extra 600 cases being diagnosed in males in 2008 than in 2007. 5

Malignant melanoma is rare in children, while in adults the incidence rates rise steadily with age (Figure 1.2). 5

Figure 1.2: Malignant Melanoma (C43), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2006-2008

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Although the rates are highest in the over 65s, a substantial number of cases are diagnosed at younger adult ages. More than a quarter (28%) of all cases occurs in people aged less than 50 years. More than two 15-34 year olds are diagnosed with malignant melanoma every day (over 900 cases were diagnosed in this age-group in 2008) and it is the second most common cancer in this age-group. This unusually young age distribution for an adult cancer emphasises the importance of its prevention and early treatment to avert the potential loss of many years of life. On average, around 20 years of life are lost for each melanoma death. 6

section updated 18/07/11

Another unusual feature of malignant melanoma is its positive association with affluence. 2,7 For Scottish patients diagnosed between 1991-95, age-standardised incidence rates in the most affluent areas were nearly twice as high as those in the most deprived areas (13.6 v 7.4 per 100,000 population). 2

In England and Wales during 1988-93, the gap was wider, with the most deprived areas having incidence rates between 60-70% lower than those for the most affluent areas. 7 A decade later, this gap had narrowed in England to a similar sized gap as seen for Scotland, with the deprived groups having 50% lower incidence rates than the affluent areas during 1998-2003 8 , and in 2000-2004 9. This difference in incidence is possibly related to access to holidays abroad, where higher intensity sun exposure is likely. The gap between the least and most deprived groups may have narrowed because more people go on holiday abroad now. In 2005 UK residents made a record 66.2 million trips abroad, three times as many as in 1985. Two-thirds of these foreign visits were holidays and just under half were package holidays. 10

The Cancer Atlas of the UK and Ireland, which analysed rates at local authority and health board level, showed that male and female melanoma incidence rates have a very similar geographical distribution. The highest rates for both sexes occur in south west England, illustrated for men in Figure 1.3. 11

Higher than average (UK and Ireland average) melanoma incidence rates were also reported for Northern Ireland, Scotland, Ireland and much of southern England. There is some suggestion that the higher rates in Scotland as well as Northern Ireland and Ireland may reflect better ascertainment of cases: another reason for the elevated rates may be the larger proportion of high risk, fair-skinned people in those populations. 11 The Atlas also showed some correlation between areas of low incidence and deprivation.

An estimated 69,000 new cases of melanoma were diagnosed in 2008 in the EU-27 countries. Within the EU, there is considerable variability of rates as shown in Figure 1.4 with the highest rates for the fairer-skinned north Europeans.12,29 The UK melanoma incidence rates for both men and women are above the EU average.

Figure 1.4: Malignant Melanoma (C43), European Age-Standardised  Incidence Rates, EU-27 Countries, 2008 Estimates

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An estimated 200,000 cases of melanoma were diagnosed worldwide in 2008. World melanoma incidence rates reflect the high risk for white populations in sunny climates with Australia and New Zealand leading the world with age-standardised rates between 32-42 per 100,000 population ( Figure 1.5) 12  (Please note that World and European age-standardised rates cannot be directly compared with each other in terms of numerical values) 

The risk factors section presents some information on incidence rates by ethnicity.

Figure 1.5: Malignant Melanoma (C43), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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section updated 18/07/11

Over the last thirty years, incidence rates of malignant melanoma in Britain have increased more rapidly than any of the top ten cancers in males and females. Figure 1.6 shows the male rates have increased more than five times from around 2.9 in 1979 to 16.0 in 2008, while the female rates have more than tripled from 4.8 to 16.5 over the same period in Great Britain. 5  Figure 1.7 shows an almost identical trend for the UK.

Figure 1.6: Malignant Melanoma (C43), European Age-Standardised Incidence Rates, Great Britain, 1975-2008

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Figure 1.7: Malignant Melanoma (C43), European Age-Standardised Incidence Rates, UK, 1993-2008

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This pattern of increasing malignant melanoma incidence rates, with a faster rate of increase for men than women, is a feature of many fair-skinned populations. 14 In Europe, the increases began first with Scandinavia and the UK and then spread to western, southern and eastern Europe. 15 In most populations the increase has been mainly for thin melanomas. 16,17

Some of the increase may be due to increased surveillance and early detection as well as changes in diagnostic criteria but most is considered to be real and linked to changes in sun behaviour as discussed in the risk factors section. 18-20

Benefits from primary prevention are not expected to lead to a significant reduction in incidence for at least two decades although the higher proportion of thinner lesions will have immediate survival benefit (see survival). 21

Worldwide, the incidence of cutaneous melanoma is increasing faster than any other common cancer with an approximate doubling of rates every 10-20 years in countries with white populations. 14

The main preventable cause is known but translating this knowledge into changes in behaviour is not easy. Surveys in the UK have revealed that the majority of people regard a sun tan as a sign of health and few are knowledgeable about the dangers of UV radiation. 22 However, there is evidence that there has been modest behavioural change particularly with regard to protecting children from over-exposure to sunlight.The report also shows that the number of people who are aware that avoiding sunbeds can reduce the risk of skin cancer has more than doubled since 2006. More public education is needed especially for high risk groups.

Vitamin D is essential for good bone health and for most people sunlight is the most important source of vitamin D. The time required to make sufficient vitamin D varies according to a number of environmental, physical and personal factors, but is has been consistently shown that it can be sufficiently produced without burning. Further research into the many unanswered questions concerning the synthesis of vitamin D from sunlight such as establishing optimal vitamin D levels and how much sun exposure is required to ensure optimal levels of vitamin D in people of different skin types and under different environmental conditions, is ongoing. In the UK, the national skin cancer prevention programme, SunSmart, is run by Cancer Research UK and mainly funded by the UK Departments of Health. 23

section updated 05/04/11

When the rates are analysed by age, it can be seen that there have been increases at all ages with the largest increase in the over 60's. 

From 1975-2008, malignant melanoma incidence rates in men aged 60-79 increased by around 790%, more than in any other age group. (Figure 1.8). 5 

Figure 1.8: Malignant Melanoma (C43), Percentage Change in European Age-Standardised Incidence Rates, Great Britain, 1975-1977 to 2006-2008

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Projections based on trends in malignant melanoma incidence from 1975-2004, suggest that incidence rates in many age groups will continue to increase up until 2024. Incidence rates in people aged 60-79 are projected to increase by a further third from where they are today. The largest projected increases in incidence rates are in people aged 80+ for whom rates are projected to increase by more than two thirds from where they are today. Male incidence rates are also projected to continue to increase by more than females rates. (Figure 1.9, 1.10 and 1.11)24 

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section updated 18/07/11

The Tumour, Node, Metastasis (TNM) staging is based on the tumour size, whether the cancer had spread to nearby nodes or whether it had spread more widely around the body with TNM stage 1 being the least and TNM stage 4 being the most developed. For the purposed of the analysis, TNM stages 1 and 2 were combined to form 'early' stage and combined TNM stages 3 and 4 for 'late' stage.

Data from Eastern Cancer Registry and Information Centre (ECRIC) 28 showed that significantly more people aged 65 and over were diagnosed with malignant melanoma at a late stage than those under 65. In recent years (between 2006-2008), seven per cent of 15-64 year olds diagnosed with malignant melanoma were at a late stage compared with around 20 per cent of those aged over 65 (Figure 1.12) There were only 2% of malignant melanoma tumours where the actual TNM stage at diagnosis was not known. The regional data from ECRIC were used because, at present, good quality consistent staging data are unavailable nationally.

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section updated 05/04/11

Prevalence data relate to those people in the UK who were alive on a specific date having previously been diagnosed with cancer. The latest analysis shows that on 31st December 2006, around 59,100 people were alive up to ten years after being diagnosed with malignant melanoma25. Table 1.2 shows the one, five and ten year prevalence by sex for malignant melanoma.

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section updated 21/12/10

Skin cancers are extremely common. In 2008 over 98,800 non-melanoma skin cancers (NMSC) were registered in the UK but registration is known to be incomplete. 

The majority of NMSCs are either basal cell carcinomas (BCCs), also known as rodent ulcers, or squamous cell carcinomas (SCCs). Both forms are highly treatable and survival rates for NMSCs are very high. However, if left untreated, these tumours can become destructive, invading local tissues and causing disfigurement.

Whilst BCCs rarely metastasise, SCC can, and in 2008 there were 491 deaths in the UK from NMSC. 2,26,27  Over 80% of NMSCs occur in people aged 60 years and over and they constitute a substantial public health problem due to the very large number of cases each year.

section updated 05/04/11