Abstract
Background:
Skin cancer is a common skin disease whose incidence and mortality rates have been showing yearly increases. In this report, we update the most recent data on skin cancer as obtained from GLOBOCAN 2022.
Methods:
The incidence and mortality rates of skin cancer (melanoma of skin and non-melanoma skin cancer) in GLOBOCAN 2022 were reviewed. These data were analyzed and the characteristics of incidence and mortality across five continents and top five countries and regions in each continent are presented. In addition, correlations between Human Development Index (HDI) and age-standardized incidence and mortality rates of these two skin cancers are described.
Results:
The GLOBOCAN 2022 data indicated that melanoma was the 17th most common cancer. An estimated 331,722 people were diagnosed with melanoma globally and approximately 58,667 died from this disease. For non-melanoma skin cancer, it ranks as the 5th most common cancer, and an estimated 1,234,533 people were diagnosed with non-melanoma skin cancer globally and approximately 69,416 died from this disease. The incidence of skin cancer varies across geographic regions and countries, with a predominance observed in Oceania, North America, and Europe. Australia was ranked first in terms of incidence, while incidence rates in Africa and Asia were very low. Despite these regional differences in incidence, there was little geographic variation in mortality rates. Currently, the number of deaths from non-melanoma skin cancer exceeds that of melanoma of skin. HDI was positively associated with the incidence of both types of skin cancers, with a positive correlation obtained between HDI and mortality from melanoma of skin and a negative correlation between HDI and mortality from non-melanoma skin cancer.
Conclusions:
Skin cancer remains a major disease burden worldwide. Substantial variations are observed across countries and regions. Further research on skin cancer will be required to provide a rationale for more effective preventions and treatments of this condition.
Keywords: Global patterns, Skin cancer, Incidence, Mortality, Prevalence, GLOBOCAN 2022
Introduction
Skin cancer is a malignant tumor originating in skin cells and represents one of the most common cancers worldwide.[1] Two main types of skin cancer which have been characterized include melanoma of skin, which originates from melanocytes, and non-melanoma skin cancer, which originates from keratinocytes. Non-melanoma skin cancer further includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, as well as other types of skin cancers.[2] Melanoma of skin is highly accretive, invasive, and metastatic, whereas BCC is generally slow-growing and rarely metastasizes, and some subtypes of malignant SCC squamous can be highly invasive and metastatic.[3]
Globally, non-melanoma skin cancer is the most common malignant tumor among Caucasians and its incidence has been increasing. It is significantly more prevalent than melanoma and exerts a serious impact on global healthcare and well-being.[4] As based on Global Cancer 2020 data, the number of new non-melanoma skin cancer cases (except for BCC) was 1,198,073, accounting for 6.2% of all cancer cases. The incidence in males is approximately twice that of females and the overall number of deaths is 63,731, accounting for 0.6% of all cancer cases (including all cancer types). For melanoma, the number of new cases is 324,635, accounting for 1.7% of all new cancer cases, and the number of deaths is 57,043, accounting for 0.6% of all cancer deaths.[5]
Risk factors for the development of skin cancer include prolonged exposure to ultraviolet (UV) light, family history, chemical carcinogens, and immunosuppressive agents. Among these factors, thymine dimers, produced by prolonged UV light exposure, can induce structural changes in DNA, which represents a significant basis for skin cancer.[3,6] Melanin, via its capacity for free radical scavenging, along with its antioxidant and UV-absorbing properties, can reduce the penetration of UV rays into the nuclei of keratinocytes.[7] As a result, the lower levels of melanin in lighter-skinned people place them at a greater risk for skin cancer. Although the incidence of skin cancer is lower in people of color compared to Caucasians, the incidence and mortality rates remain relatively high, with dark-skinned people being more prone to SCC. Therefore, skin cancer represents a disease that cannot be ignored in any of the races.[8]
The aim of this paper is to update the data and global epidemiological patterns of skin cancer based on the incidence and mortality rates provided by the latest release of global cancer statistics for 2022. The factors contributing to differences in incidence and mortality rates among the different types of skin cancer are further analyzed and described. Such information can provide important, new perspectives for the prevention and treatment of skin cancer worldwide.
Methods
Data sources
The International Classification of Diseases 10th Revision (ICD-10) codes C43 and C44 (excluding BCC incidence) for melanoma of skin and non-melanoma skin cancer incidence and mortality rates were obtained from the International Agency for Research on Cancer (IARC) Global Cancer 2022 (GLOBOCAN 2022) database. GLOBOCAN 2022 provides a comprehensive assessment of the incidence, mortality, and prevalence of 36 cancers in 185 countries or territories, separated by sex and within 18 distinct age groups at 5-year intervals (ages 0–4 years, 5–9 years, …, 80–84 years, and ≥85 years). Estimation methods vary by country, and the quality of national estimates depends on the coverage, accuracy, and timeliness of incidence and mortality data as recorded in a given country. Incidence and mortality can be expressed as the absolute number of cases per year within the entire population or as the incidence/mortality rates per 100,000 persons per year (age-standardized incidence rate [ASIR]/age-standardized mortality rate [ASMR]). Standardization is necessary when making comparisons among differently aged individuals, as age has a strong influence on cancer risk. These data are visualized in CANCER TODAY (https://gco.iarc.who.int/today/) as bar/pie charts, heat maps, scatter plots, and tables. It is important to note that the recent incidence of non-melanoma skin cancers as reported in the GLOBOCAN 2022 data excludes BCC, but mortality rates include all types of non-melanoma skin cancers.
Data analysis
In this study, we presented a descriptive secondary analysis of skin cancer incidence and mortality rates along with their variations across regions and populations based on data from the GLOBOCAN 2022. We compared the number of new cases, deaths, crude death rates, ASIR, and ASMR between melanoma of skin and non-melanoma skin cancer within the five continents and top five countries and regions in each continent. We also described the most recent rankings of skin cancer in the GLOBOCAN 2022 database, the overall global ASIR and ASMR, and the number of new cases and deaths. The trends in ASIR and ASMR for both skin cancers were plotted according to age group. Data processing and analysis were carried out using Python 3.11. This software is maintained by the Python Software Foundation (Python Software Foundation, https://www.python.org/).
Cancer incidence data from the Cancer Incidence in Five Continents Time Trends (CI5plus) database, which contains updated annual incidence rates for 124 selected populations from 108 cancer registries as published in CI5, were used to assess the temporal trends of melanoma. In order to include as many countries and regions as possible in the assessment, continuous melanoma surveillance data were extracted from databases for all five continents over the period from 1998 to 2012. In addition, the number of cases and populations at risk were recorded and the crude incidence rates and world standardized incidence rates, as calculated using the Segi’s World Standard Population, were also calculated along with the standard errors for crude rates and age-adjusted rates for time trend analyses. As age may impact analysis, results from the world standardized incidence rates were ultimately used to analyze trends. The Joinpoint 5.1.0 (https://surveillance.cancer.gov/joinpoint/) was then used to analyze time trends in incidence rates using a log-linear model with a model restriction of two linkages, as well as to calculate the annual average percent change (AAPC).
The Human Development Index (HDI) classifies global levels of economic development into four tiers: very high, high, medium, and low. Correlation analyses were performed between HDI and ASIR and ASMR for the two skin cancers using GraphPad Prism 9.5.0 (http://www.graphpad.com). Spearman’s correlation coefficient was used to measure the monotonic relationship between the variables, with correlation coefficients ranging from −1 (perfect negative correlation) to 0 (no correlation) to +1 (perfect positive correlation).
Results
Melanoma of skin incidence and mortality rates in 2022
The GLOBOCAN 2022 data indicated that melanoma was the 17th most common cancer. An estimated 331,722 people were diagnosed with melanoma globally and approximately 58,667 died from this disease. Crude incidence and world ASIR per 100,000 people were 4.20 and 3.20, respectively. The incidence and mortality of melanoma varied significantly across continents and regions. Oceania, North America, and Europe had the top three ASIR per 100,000 people with rates being 29.80, 16.30, and 10.40, respectively. In Africa and Asia, ASIRs were substantially lower than that of world ASIR, with rates being 0.90 and 0.41 per 100,000 people, respectively. The highest incidence rates in countries and regions were in Australia with an ASIR of 37.00 per 100,000 people, followed by Denmark (31.10) and Norway (30.60). In Australia, melanoma accounted for 7.9% of all cancer cases with 16,819 cases (the top three cancers were breast, prostate, and colorectal), ranking fourth among all cancers. The number of deaths from melanoma was 1393, accounting for 2.7% of all cancers, ranking 12th among all cancers. [Table 1].
Table 1.
The top five countries and regions in ASIR or ASMR of MSC or NMSC for each continent based on data from GLOBALCAN 2022.
| Continents/HDI | MSC | NMSC | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Incidence | Mortality | Incidence | Mortality | |||||||||
| Crude rate* | ASIR* | Population | Crude rate* | ASMR* | Population | Crude rate* | ASIR* | Population | Crude rate* | ASMR* | Population | |
| World | 4.20 | 3.20 | 331,722 | 0.74 | 0.53 | 58,667 | 15.70 | 10.40 | 1,234,533 | 0.88 | 0.59 | 69,416 |
| Very high HDI | 17.30 | 9.50 | 283,894 | 2.40 | 1.10 | 38,992 | 63.60 | 24.40 | 1,043,878 | 1.50 | 0.49 | 23,834 |
| High HDI | 1.30 | 0.90 | 35,953 | 0.50 | 0.33 | 13,849 | 5.20 | 3.30 | 143,802 | 0.99 | 0.59 | 27,405 |
| Medium HDI | 0.35 | 0.37 | 7890 | 0.18 | 0.19 | 4001 | 1.20 | 1.30 | 28,205 | 0.44 | 0.48 | 10,042 |
| Low HDI | 0.32 | 0.60 | 3918 | 0.15 | 0.29 | 1823 | 1.50 | 2.50 | 18,154 | 0.67 | 1.30 | 8104 |
| Oceania | 45.30 | 29.80 | 19,823 | 4.40 | 2.30 | 1902 | 164.90 | 113.60 | 72,145 | 2.80 | 1.30 | 1218 |
| Australia | 64.50 | 37.00 | 16,819 | 5.30 | 2.20 | 1393 | 233.20 | 140.10 | 60,803 | 2.90 | 1.00 | 758 |
| New Zealand | 55.90 | 29.80 | 2739 | 9.20 | 3.90 | 449 | 216.50 | 127.50 | 10,606 | 3.90 | 1.30 | 190 |
| New Caledonia | 8.60 | 6.50 | 25 | 0.00 | 0.00 | 0 | 8.90 | 6.00 | 26 | 0.34 | 0.17 | 1 |
| French Polynesia | 6.70 | 5.10 | 19 | 0.70 | 0.55 | 2 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 |
| Papua New Guinea | 2.30 | 3.30 | 210 | 0.62 | 0.99 | 58 | 7.50 | 13.60 | 699 | 2.90 | 5.50 | 267 |
| Northern America | 30.20 | 16.30 | 112,807 | 2.30 | 1.10 | 8737 | 162.80 | 62.20 | 607,867 | 1.50 | 0.59 | 5701 |
| USA | 30.30 | 16.50 | 101,388 | 2.20 | 1.00 | 7368 | 163.60 | 63.30 | 547,639 | 1.40 | 0.57 | 4791 |
| Canada | 29.70 | 14.50 | 11,383 | 3.60 | 1.40 | 1369 | 156.40 | 53.50 | 60,024 | 2.40 | 0.69 | 910 |
| Europe | 19.60 | 10.40 | 146,321 | 3.50 | 1.50 | 26,180 | 44.20 | 14.20 | 330,062 | 1.80 | 0.50 | 13,111 |
| Denmark | 53.90 | 31.10 | 3144 | 5.50 | 2.10 | 321 | 83.60 | 24.90 | 4876 | 1.60 | 0.41 | 93 |
| Norway | 57.50 | 30.60 | 3169 | 6.40 | 2.60 | 353 | 51.80 | 17.70 | 2856 | 1.30 | 0.36 | 70 |
| Sweden | 51.50 | 27.40 | 5259 | 5.30 | 2.00 | 536 | 73.10 | 21.20 | 7467 | 1.10 | 0.26 | 108 |
| The Netherlands | 47.80 | 25.90 | 8221 | 5.10 | 2.10 | 875 | 93.50 | 29.00 | 16,095 | 0.80 | 0.21 | 137 |
| Belgium | 35.70 | 21.10 | 4163 | 3.40 | 1.50 | 395 | 72.40 | 23.00 | 8452 | 1.10 | 0.30 | 130 |
| Montenegro | 12.70 | 7.40 | 80 | 4.60 | 2.40 | 29 | 36.50 | 16.90 | 229 | 2.20 | 0.81 | 14 |
| Slovenia | 32.20 | 17.10 | 668 | 5.90 | 2.30 | 122 | 32.90 | 9.20 | 683 | 3.00 | 0.69 | 62 |
| Croatia | 23.80 | 11.90 | 966 | 5.50 | 2.30 | 224 | 32.00 | 7.40 | 1297 | 2.90 | 0.64 | 117 |
| Slovakia | 19.00 | 10.50 | 1039 | 4.50 | 2.10 | 248 | 30.00 | 11.50 | 1640 | 2.30 | 0.79 | 123 |
| Ireland | 31.20 | 18.10 | 1567 | 4.00 | 2.00 | 202 | 86.80 | 37.70 | 4358 | 2.60 | 0.97 | 128 |
| Switzerland | 27.60 | 13.40 | 2419 | 3.40 | 1.20 | 299 | 116.00 | 37.50 | 10,177 | 1.80 | 0.40 | 154 |
| Luxembourg | 23.70 | 15.40 | 152 | 2.00 | 0.99 | 13 | 71.10 | 28.10 | 457 | 0.62 | 0.20 | 4 |
| Latin America and the Caribbean | 3.10 | 2.40 | 20,291 | 0.88 | 0.65 | 5842 | 11.00 | 7.70 | 72,981 | 1.20 | 0.79 | 8090 |
| Uruguay | 7.20 | 4.50 | 251 | 2.30 | 1.10 | 81 | 14.50 | 7.20 | 2794 | 1.30 | 0.42 | 47 |
| Paraguay | 3.70 | 3.80 | 267 | 1.20 | 1.20 | 86 | 5.50 | 5.50 | 403 | 1.20 | 1.00 | 84 |
| Belize | 2.90 | 3.50 | 12 | 0.00 | 0.00 | 0 | 8.30 | 9.30 | 34 | 0.00 | 0.00 | 0 |
| Chile | 5.00 | 3.30 | 962 | 1.50 | 0.87 | 290 | 14.50 | 7.20 | 2794 | 1.50 | 0.63 | 286 |
| Brazil | 4.50 | 3.30 | 9676 | 1.10 | 0.73 | 2273 | 16.50 | 10.80 | 35,533 | 1.40 | 0.87 | 3073 |
| Peru | 4.00 | 3.20 | 1360 | 1.30 | 0.93 | 443 | 9.10 | 6.20 | 3062 | 1.10 | 0.76 | 384 |
| Argentina | 3.50 | 2.60 | 1603 | 1.20 | 0.84 | 563 | 8.10 | 5.10 | 3731 | 0.93 | 0.52 | 427 |
| Costa Rica | 2.60 | 1.80 | 134 | 1.10 | 0.70 | 59 | 29.10 | 18.40 | 1508 | 1.50 | 0.81 | 78 |
| Venezuela | 1.70 | 1.50 | 492 | 0.51 | 0.42 | 149 | 14.80 | 11.40 | 4334 | 2.30 | 1.80 | 665 |
| Puerto Rico | 3.70 | 1.70 | 105 | 0.81 | 0.28 | 23 | 21.40 | 11.00 | 605 | 1.80 | 0.46 | 50 |
| Ecuador | 2.70 | 2.50 | 491 | 0.87 | 0.73 | 158 | 7.00 | 5.60 | 1275 | 1.40 | 1.00 | 255 |
| Guatemala | 0.37 | 0.48 | 69 | 0.16 | 0.20 | 30 | 2.70 | 3.00 | 497 | 0.87 | 1.00 | 162 |
| Africa | 0.53 | 0.90 | 7477 | 0.20 | 0.37 | 2859 | 2.20 | 3.50 | 30,632 | 0.66 | 1.20 | 9269 |
| South Africa | 3.70 | 4.10 | 2231 | 1.10 | 1.30 | 649 | 17.20 | 19.80 | 10,424 | 1.50 | 1.80 | 901 |
| Namibia | 2.50 | 4.10 | 65 | 0.84 | 1.50 | 22 | 8.80 | 14.30 | 231 | 2.50 | 4.50 | 67 |
| France, La Réunion | 4.30 | 3.10 | 39 | 1.20 | 0.70 | 11 | 0.11 | 0.04 | 1 | 0.11 | 0.04 | 1 |
| Zimbabwe | 1.10 | 2.20 | 163 | 0.45 | 0.95 | 69 | 2.70 | 4.80 | 413 | 0.91 | 2.00 | 140 |
| Malawi | 1.10 | 2.10 | 218 | 0.42 | 0.92 | 85 | 1.80 | 3.20 | 371 | 0.88 | 1.90 | 177 |
| Botswana | 1.20 | 1.70 | 30 | 0.41 | 0.57 | 10 | 3.90 | 4.80 | 95 | 0.78 | 1.10 | 19 |
| Mauritius | 0.39 | 0.24 | 5 | 0.00 | 0.00 | 0 | 7.30 | 4.20 | 93 | 0.00 | 0.00 | 0 |
| Somalia | 0.27 | 0.58 | 45 | 0.14 | 0.31 | 23 | 1.50 | 3.00 | 258 | 0.90 | 2.00 | 152 |
| Ethiopia | 0.21 | 0.35 | 255 | 0.10 | 0.16 | 117 | 2.10 | 3.40 | 2544 | 1.00 | 1.90 | 1237 |
| Asia | 0.54 | 0.41 | 25,003 | 0.28 | 0.21 | 13,147 | 2.60 | 1.90 | 120,846 | 0.69 | 0.49 | 32,027 |
| Israel | 14.80 | 10.80 | 1317 | 2.50 | 1.40 | 223 | 2.30 | 1.50 | 204 | 1.60 | 0.61 | 140 |
| Georgia | 7.60 | 4.50 | 302 | 2.10 | 1.00 | 84 | 12.70 | 5.30 | 505 | 5.60 | 2.10 | 221 |
| Armenia | 2.70 | 1.80 | 79 | 0.67 | 0.41 | 20 | 4.10 | 2.40 | 123 | 1.20 | 0.64 | 37 |
| Türkiye | 2.10 | 1.70 | 1783 | 1.00 | 0.76 | 864 | 9.60 | 7.30 | 8229 | 0.67 | 0.46 | 573 |
| Brunei Darussalam | 1.80 | 1.60 | 8 | 0.22 | 0.26 | 1 | 5.20 | 5.10 | 23 | 0.00 | 0.00 | 0 |
| Kazakhstan | 1.50 | 1.30 | 280 | 0.89 | 0.75 | 171 | 11.00 | 9.00 | 2109 | 0.79 | 0.63 | 152 |
| Turkmenistan | 0.66 | 0.77 | 41 | 0.42 | 0.49 | 26 | 4.00 | 4.80 | 246 | 0.58 | 0.70 | 36 |
| Pakistan | 0.23 | 0.31 | 517 | 0.12 | 0.17 | 284 | 2.10 | 2.90 | 4810 | 1.00 | 1.40 | 2237 |
| Lebanon | 1.30 | 1.10 | 86 | 0.37 | 0.30 | 25 | 5.20 | 4.20 | 344 | 1.90 | 1.40 | 129 |
| Syrian Arab Republic | 0.67 | 0.83 | 130 | 0.23 | 0.30 | 44 | 2.20 | 2.80 | 421 | 0.24 | 0.38 | 87 |
| Afghanistan | 0.25 | 0.49 | 103 | 0.14 | 0.29 | 57 | 1.30 | 2.70 | 525 | 0.52 | 1.20 | 211 |
ASIR: Age-standardized incidence rates; ASMR: Age-standardized mortality rates; HDI: Human Development Index; MSC: Melanoma of skin; NMSC: Non-melanoma skin cancer. * per 100,000 people.
For ASMR, Oceania, Europe, and North America maintained their leading positions, with ASMR per 100,000 people being 2.30, 1.50, and 1.10, respectively. The ASMRs for Africa and Asia were again, markedly lower being 0.37 and 0.21 per 100,000 people, respectively. New Zealand had the highest mortality rates for melanoma, with an ASMR of 3.90 and a crude mortality rate of 9.20 per 100,000 people [Table 1].
An increasing trend in ASMR and ASIR as a function of age was observed within selected countries and regions (top five countries and regions in terms of age-standardized rates) in terms of continents. In all countries and regions investigated, the ASIRs of melanoma of skin were relatively low below the age of 20 years but increased thereafter [Supplementary Figure 1, http://links.lww.com/CM9/C252]. In most countries and regions, ASMR and ASIR peaked at ≥80 years. Interestingly, in French Polynesia and France, La Réunion, ASMR peaked at 70 years of age [Supplementary Figures 1 and 2, http://links.lww.com/CM9/C252]. Based on the prevalence in the 1-year, 3-year, and 5-year analyses, European showed the highest prevalence of cases followed by America, with prevalent cases peaking at age 60 years in Europe [Figure 1].
Figure 1.
Prevalence of melanoma (A) and non-melanoma skin cancer (B) in five continents with the 1-year, 3-year, and 5-year analyses based on data from GLOBALCAN 2022.
Non-melanoma skin cancer incidence and mortality rates in 2022
Non-melanoma skin cancer ranked as the 5th most common cancer. An estimated 1,234,533 people were diagnosed with non-melanoma skin cancer globally and approximately 69,416 died from this disease. The top three continents for ASIR were Oceania, North America, and Europe, which was consistent with that of melanoma. The highest ASIR was in Australia with an ASIR of 140.10 per 100,000 people and a crude incidence rate of 233.20 per 100,000 people, followed by ASIR of 127.50 and 63.30 per 100,000 in New Zealand and America, respectively. Similar significant variations across regions and countries, as well as mortality rates, were obtained for non-melanoma skin cancer as that observed with melanoma. However, differences between the two cancers were present with regard to countries and regions showing the highest ASMR, with the highest rate being in Papua New Guinea in Oceania, followed by Namibia in Africa and Georgia in Asia [Table 1].
With the exception of New Zealand and Australia, in most of the countries and regions surveyed, the ASIR of non-melanoma skin cancer was relatively low below the age of 40 years but increased after this age. In contrast, in New Zealand and Australia, there was a sharp increase in ASIR observed after 30 years of age [Supplementary Figure 3, http://links.lww.com/CM9/C252]. For ASMR, with the exception of countries and regions in Oceania, there was an increasing trend with age after age 40. In the Oceania countries and regions, with the exception of the Solomon Islands, there was a clear upward trend at about age 70 [Supplementary Figure 4, http://links.lww.com/CM9/C252]. America had the highest prevalence of cases with peaking at age 80 years. This was followed by Europe and Asia. With the increase of age, the prevalence of non-melanoma skin cancer in all countries and regions generally shows an upward trend, and non-melanoma skin cancer is more common among the elderly population [Figure 1].
For both skin cancers, there was a large difference in ASIR by countries and regions, but small differences in ASMR. For melanoma, ASIR varied by 154-fold between countries and regions, from 37.00 per 100,000 people in Australia to 0.24 in Mauritius. Such differences were even more pronounced for non-melanoma skin cancer, where ASIR varied by up to 3500-fold between countries and regions, from 140.10 per 100,000 people in Australia to 0.04 in France, La Réunion (Although French Polynesia has the smallest ASIR of 0, to calculate the difference between the largest and smallest countries and regions, we used data from La Réunion, which has the second-smallest ASIR after French Polynesia) [Table 1].
Skin cancer and HDI
For non-melanoma skin cancer, the ASMR was the highest among countries with low HDI levels, reaching 1.30 per 100,000 people. While, the ASIR was the highest in the very high HDI levels, reaching 24.40 per 100,000 people. Countries with very high HDI levels had the highest ASIR (9.50) and ASMR (1.10) per 100,000 people for melanoma [Table 1].
For melanoma, the ASIR in countries with very high HDI levels was approximately 26 times greater and ASMR about 6 times greater than that in countries with medium HDI. For non-melanoma skin cancer, ASIR in countries with very high HDI levels was approximately 19 times that of countries with medium HDI, while the ASMR in countries with low HDI levels was approximately three times that as observed in countries with very high HDI levels. Countries with medium HDI had the lowest ASIR and ASMR for both skin cancers. Countries with very high HDI levels accounted for 85.58% of new melanoma cases and 66.46% of deaths, while countries with medium and low HDI levels accounted for 3.56% of new cases and 9.93% of deaths. For non-melanoma skin cancers, countries with very high levels of HDI accounted for 84.56% of new cases and 34.34% of deaths, while countries with medium and low HDI levels accounted for 3.76% of new cases and 26.14% of deaths [Table 1].
Figure 2 contains a summary of results from the correlations performed between HDI and non-melanoma skin cancers and melanoma. The ASIR of non-melanoma skin cancers was positively correlated with HDI, with increases in ASIR being associated with increases in levels of HDI (r = 0.5083, P <0.0001). ASMR of non-melanoma skin cancers was negatively correlated with HDI, with these mortality rates showing a decrease as levels of HDI increased (r = −0.3844, P <0.0001). The ASIR of melanoma was positively correlated with HDI levels (r = 0.5080, P <0.0001). The ASMR of melanoma was also positively correlated with HDI, with increases in levels of HDI being accompanied with increases in ASMR (r = 0.4290, P <0.0001).
Figure 2.
Correlations between HDI and age-standardized morbidity and mortality in non-melanoma skin cancer (A) and melanoma of skin (B) based on data from GLOBALCAN 2022. The horizontal axis of the graph denotes the HDI levels. ASIR: Age-standardized incidence rates; ASMR: Age-standardized mortality rates; HDI: Human Development Index.
Skin cancer and gender
Except for Africa, where the ASIR for melanoma was higher in females, males show higher rates for both cancers in all other regions [Table 2]. These results of ASMR were similar to those of the ASIR, with higher rates for both cancers in males, except for melanoma in Africa, where the ASMR of melanoma was higher in females than in males [Table 3]. Over the period from 1998 to 2012, the AAPC values obtained for European males (5.25%, P <0.001) and females (4.01%, P <0.001), Oceania males (1.59%, P <0.001) and females (0.96%, P <0.05), Asian males (2.91%, P <0.001) and females (2.03%, P <0.001), as well as in American males (2.71%, P <0.001) and females (2.63%, P <0.001) all showed a statistically significant increasing trend for the ASIR of melanoma. AAPC values could not be calculated for males in Africa, while those in females (0.14%, P = 0.82) failed to show any statistically significant trend.
Table 2.
Skin cancer incidence rates in males and females based on data from GLOBALCAN 2022.
| Continents | MSC | NMSC | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Male | Female | Male | Female | |||||||||
| Crude rate* | ASIR* | Population | Crude rate* | ASIR* | Population | Crude rate* | ASIR* | Population | Crude rate* | ASIR* | Population | |
| World | 4.50 | 3.70 | 179,953 | 3.90 | 2.90 | 151,769 | 18.80 | 14.10 | 744,785 | 12.50 | 7.50 | 489,748 |
| Africa | 0.48 | 0.88 | 3351 | 0.59 | 0.94 | 4126 | 2.30 | 4.00 | 15,786 | 2.10 | 3.20 | 14,846 |
| Latin America and the Caribbean | 3.30 | 2.80 | 10,687 | 2.80 | 2.20 | 9604 | 13.20 | 10.60 | 43,271 | 8.80 | 5.40 | 29,710 |
| Northern America | 36.40 | 19.00 | 67,217 | 24.20 | 14.30 | 45,590 | 210.10 | 87.10 | 388,180 | 116.50 | 42.20 | 219,687 |
| Europe | 20.30 | 11.00 | 73,364 | 18.90 | 10.10 | 72,957 | 53.20 | 20.00 | 192,072 | 35.70 | 10.20 | 137,990 |
| Oceania | 57.40 | 37.40 | 12,570 | 33.20 | 23.10 | 7253 | 189.90 | 137.20 | 41,589 | 139.80 | 91.20 | 30,556 |
| Asia | 0.54 | 0.44 | 12,764 | 0.54 | 0.40 | 12,239 | 2.70 | 2.10 | 63,887 | 2.50 | 1.70 | 56,959 |
ASIR: Age-standardized incidence rates; MSC: Melanoma of skin; NMSC: Non-melanoma skin cancer. * per 100,000 people.
Table 3.
Skin cancer mortality rates in males and females based on data from GLOBALCAN 2022.
| Continents | MSC | NMSC | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Male | Female | Male | Female | |||||||||
| Crude rate* | ASMR* | Population | Crude rate* | ASMR* | Population | Crude rate* | ASMR* | Population | Crude rate* | ASMR* | Population | |
| World | 0.83 | 0.65 | 33,160 | 0.65 | 0.43 | 25,507 | 1.00 | 0.77 | 39,688 | 0.76 | 0.45 | 29,728 |
| Africa | 0.18 | 0.36 | 1293 | 0.22 | 0.37 | 1566 | 0.68 | 1.30 | 4761 | 0.64 | 1.10 | 4508 |
| Latin America and the Caribbean | 1.00 | 0.82 | 3281 | 0.76 | 0.51 | 2561 | 1.40 | 1.10 | 4599 | 1.00 | 0.57 | 3491 |
| Northern America | 3.10 | 1.50 | 5728 | 1.60 | 0.74 | 3009 | 2.20 | 0.94 | 4051 | 0.88 | 0.29 | 1650 |
| Europe | 4.10 | 1.90 | 14,619 | 3.00 | 1.20 | 11,561 | 2.10 | 0.74 | 7388 | 1.50 | 0.33 | 5723 |
| Oceania | 5.40 | 3.00 | 1192 | 3.30 | 1.70 | 710 | 3.60 | 1.90 | 795 | 1.90 | 0.82 | 423 |
| Asia | 0.30 | 0.24 | 7047 | 0.27 | 0.19 | 6100 | 0.76 | 0.60 | 18,094 | 0.61 | 0.38 | 13,933 |
ASMR: Age-standardized mortality rates; MSC: Melanoma of skin; NMSC: Non-melanoma skin cancer. * per 100,000 people.
Discussion
Melanoma and non-melanoma skin cancers account for a significant proportion of global cancers,[9] with large geographic and ethnic variations, especially among Caucasians chronically exposed to UV rays.[10] The incidence of skin cancers has been showing yearly increases.[11] Although relative mortality rates of non-melanoma skin cancer are less than that of melanoma, the overall amount of morbidity and mortality resulting from non-melanoma skin cancer far exceeds that of melanoma globally. Accordingly, there has been an increasing amount of interest and attention directed to non-melanoma skin cancer in recent years.[12]
Results from epidemiological analyses, as based on the latest data from GLOBOCAN 2022, have indicated that the incidence of these two types of skin cancers in 2022 varied considerably across countries and regions. The highest rates were found in Australia, with Oceania, North America, and Europe also showing high rates of prevalence. These high-latitude countries and regions are dominated by Caucasian populations that receive relatively high and prolonged levels of UV ray exposures. In contrast, incidence rates in Africa and Asia are relatively low. Non-melanoma skin cancer has a higher incidence, but mortality rates are less than that of melanoma. Although there were no significant geographical differences in mortality rates between the two types of skin cancers, it is worth noting that the number of deaths from non-melanoma skin cancer exceeded that of melanoma. In addition, the burden of skin cancer is associated with HDI, with countries having very high levels of HDI showing significantly higher incidences of skin cancer than that observed in countries with medium to low HDI levels. Interestingly, there was a downward trend in ASMR for non-melanoma skin cancer and an upward trend for melanoma as HDI values increased. Morbidity and mortality tend to increase with age in most countries and regions, particularly for melanoma, where a clear trend for increases in incidence was observed after the age of 20 years. For non-melanoma skin cancers, a clear increasing trend in incidence was observed after the age of 40 years, and in New Zealand and Australia, a rapid increase was present after 30 years of age. Like that reported previously,[13] we found that globally, melanoma incidence and mortality continues on an upward trend with the majority of the population reaching a peak after the age of 80 years and is more prevalent in males than females, which may be related to the fact that males are more likely to participate in outdoor sports/activities. In this report, we have included a direct comparison between melanoma and non-melanoma skin cancers to emphasize and highlight the importance of non-melanoma skin cancer in the global cancer landscape. With this analysis, the incidence trends of these diseases, as based on age and gender, provide new avenues and insights for in-depth research on skin cancer.
Results from several epidemiological studies have indicated that the incidence of skin cancer has been increasing over time. The prevalence of both non-melanoma and melanoma skin cancers varies widely across the globe, with the highest prevalence in Australia and the lowest in parts of Africa.[14,15,16,17] Recent epidemiological findings project that there will be 96,000 new melanoma cases in 2040 based on the incidence rates of 51,000 melanoma cases in 2020. Such increases will exert a huge disease burden in fair-skinned people of European descent.[13] In addition, non-melanoma skin cancer poses a significant global healthcare burden as well, with studies showing that this condition represents the fifth highest healthcare costs in Australia, America, and Europe (after prostate, lung, colon, and breast cancers).[18,19] In addition, the significant age differences in the incidence of melanoma are also a matter of some concern. An observational study based on the National Program of Cancer Registries-Surveillance Epidemiology and End Results United States Cancer Statistics database found that, while the incidence of melanoma in the United States, as well as in central Canada, has declined within adolescents and young adults, this downward trend is not as pronounced among Hispanics and young children and has actually increased in older populations.[20,21,22] Interestingly, the gender differences in melanoma incidence are associated with specific anatomical sites, with males showing increased prevalence in the head, neck, and trunk and females in the lower limbs and buttocks. This regional specificity may, in part, explain the earlier onset of melanoma incidence in women vs. men.[23,24]
As based on the Global Burden of Disease (GBD) database, the incidence of BCC and SCC has been on the rise in most countries and regions, but mortality rates for SCC have been declining. In addition, incidence and mortality rates for SCC in men are significantly greater in almost all countries and regions. It has been suggested that SCC is associated with cumulative amounts of solar ultraviolet radiation (UVR) exposure over time, whereas BCC appears to be due to an intense sun exposure in early life and genetic factors.[25] In general, long-term exposure to UVR is a common risk factor for both melanoma and non-melanoma skin cancers, however, findings from some studies have suggested that SCC is mainly attributable to long-term chronic sunlight exposure, while BCC occurs in areas that are infrequently exposed to sunlight. The higher prevalence rates for both BCC and SCC in men may be due to the fact that men are more likely to work and/or be more active outdoors and use less sunscreen than women.[10] A large proportion of skin cancers (SCC and melanoma) in Australia are due to high levels of UVR in the environment, while widespread and regular use of sunscreen may reduce the incidence of skin cancer by 10–15%.[26] However, evidence-based studies examining whether sunscreens are effective in preventing BCC or SCC remain inconclusive.[27] The number of moles represents another risk factor for melanoma with results from an observational study indicating that melanoma patients had more moles on the head and forearms than that of BCC patients.[28] In addition, the number of limb nevi can serve as a risk grading of BCC and melanoma at body sites, but is not strongly associated with SCC.[29] Results from a meta-analysis study suggest that a previous history of non-melanoma skin cancer is associated with an increased risk of melanoma, especially in patients with a history of both BCC and SCC. Moreover, female patients with head and neck melanoma were found to be more strongly associated with having a history of non-melanoma skin cancer.[30]
This study has some limitations. Notably, the incidence of BCC, but not SCC, is strongly associated with geographic variation, however, the incidence and number of cases of non-melanoma skin cancers estimated by GLOBOCAN2022 do not include BCC cases. BCC is very common among non-melanoma skin cancers in the United States, with an estimated incidence of more than 600,000 cases per year. Of these, approximately 500,000 are BCCs, with the remaining 100,000 being SCCs.[31] Such findings can have considerable implications for the interpretation of our results as they may have underestimated the prevalence and number of non-melanoma skin cancer cases. High-quality epidemiological data on the incidence of non-melanoma skin cancer are scarce, and traditional cancer registries often exclude or collect incomplete data on non-melanoma skin cancer. Accordingly, differences between BCC and SCC, the two common non-melanoma skin cancers, and the factors associated with the differences in melanoma incidence and mortality will require further investigation. In addition, as we have demonstrated significant correlations between age and skin cancer, a discussion of age warrants increased emphasis and the differential trends for morbidity and mortality as observed among young children, adolescents, and the elderly need further research. In this study, we did not provide a projection of the skin cancer disease burden for 2050. Further analyses on these trends in the disease burden of skin cancer are required to better provide a basis for prevention and treatment at the national and regional levels.
In conclusion, we analyzed melanoma and non-melanoma cancers based on the latest update of the GLOBOCAN 2022. Skin cancers, especially non-melanoma skin cancers, account for a large proportion of cancers globally. These cancers vary significantly by geographic region and ethnicity and tend to increase with age. Skin cancers are more prevalent in the elderly, males, and in Caucasians with chronic exposure to UV rays. Early intervention and timely treatment of skin cancer remain a critical clinical issue. Reducing sun exposure along with early detection and treatment are essential for high-risk groups such as individuals with long-term exposures to UV rays, Caucasians, and the elderly. Future research directed at investigating the pathogenesis and etiology of skin cancer is sorely needed to enable the development of more effective prevention and treatment strategies for skin cancers.
Funding
This research was supported by the grants from the National Key R&D Program of China (No. 2023YFC2508200), National Natural Science Foundation of China (No. 82273538), and the Public Health Research and Development Program of the Shenyang Science and Technology Bureau (No. 22-321-33-12).
Statement
All the data were obtained from the CI5plus database (Cancer Incidence in Five Continents Time Trends), IARC (International Agency for Research on Cancer), and GLOBOCAN database in 2022.
Conflicts of interest
None
Supplementary Material
Footnotes
How to cite this article: Wang MY, Gao XH, Zhang L. Recent global patterns in skin cancer incidence, mortality, and prevalence. Chin Med J 2025;138:185–192. doi: 10.1097/CM9.0000000000003416
References
- 1.Hasan N Nadaf A Imran M Jiba U Sheikh A Almalki WH, et al. Skin cancer: Understanding the journey of transformation from conventional to advanced treatment approaches. Mol Cancer 2023;22:168. doi: 10.1186/s12943-023-01854-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Khayyati Kohnehshahri M Sarkesh A Mohamed Khosroshahi L HajiEsmailPoor Z Aghebati-Maleki A Yousefi M, et al. Current status of skin cancers with a focus on immunology and immunotherapy. Cancer Cell Int 2023;23:174. doi: 10.1186/s12935-023-03012-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Nakayama K. Growth and progression of melanoma and non-melanoma skin cancers regulated by ubiquitination. Pigment Cell Melanoma Res 2010;23:338–351. doi: 10.1111/j.1755-148X.2010.00692.x. [DOI] [PubMed] [Google Scholar]
- 4.Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of non-melanoma skin cancer. Br J Dermatol 2012;166:1069–1080. doi: 10.1111/j.1365-2133.2012.10830.x. [DOI] [PubMed] [Google Scholar]
- 5.Sung H Ferlay J Siegel RL Laversanne M Soerjomataram I Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209–249. doi: 10.3322/caac.21660. [DOI] [PubMed] [Google Scholar]
- 6.Nanz L, Keim U, Katalinic A, Meyer T, Garbe C, Leiter U. Epidemiology of keratinocyte skin cancer with a focus on cutaneous squamous cell carcinoma. Cancers (Basel) 2024;16:606. doi: 10.3390/cancers16030606. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Zamudio Díaz DF Busch L Kröger M Klein AL Lohan SB Mewes KR, et al. Significance of melanin distribution in the epidermis for the protective effect against UV light. Sci Rep 2024;14:3488. doi: 10.1038/s41598-024-53941-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Gloster HM, Jr., Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006;55:741–760;quiz761–764. doi: 10.1016/j.jaad.2005.08.063. [DOI] [PubMed] [Google Scholar]
- 9.Aggarwal P, Knabel P, Fleischer AB, Jr. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J Am Acad Dermatol 2021;85:388–395. doi: 10.1016/j.jaad.2021.03.109. [DOI] [PubMed] [Google Scholar]
- 10.Xiang F, Lucas R, Hales S, Neale R. Incidence of nonmelanoma skin cancer in relation to ambient UV radiation in white populations, 1978-2012: Empirical relationships. JAMA Dermatol 2014;150:1063–1071. doi: 10.1001/jamadermatol.2014.762. [DOI] [PubMed] [Google Scholar]
- 11.Woo YR, Cho SH, Lee JD, Kim HS. The human microbiota and skin cancer. Int J Mol Sci 2022;23:1813. doi: 10.3390/ijms23031813. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Pega F Momen NC Streicher KN Leon-Roux M Neupane S Schubauer-Berigan MK, et al. Global, regional and national burdens of non-melanoma skin cancer attributable to occupational exposure to solar ultraviolet radiation for 183 countries, 2000-2019: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int 2023;181:108226. doi: 10.1016/j.envint.2023.108226. [DOI] [PubMed] [Google Scholar]
- 13.Arnold M Singh D Laversanne M Vignat J Vaccarella S Meheus F, et al. Global burden of cutaneous melanoma in 2020 and projections to 2040. JAMA Dermatol 2022;158:495–503. doi: 10.1001/jamadermatol.2022.0160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Arnold M Holterhues C Hollestein LM Coebergh JW Nijsten T Pukkala E, et al. Trends in incidence and predictions of cutaneous melanoma across Europe up to 2015. J Eur Acad Dermatol Venereol 2014;28:1170–1178. doi: 10.1111/jdv.12236. [DOI] [PubMed] [Google Scholar]
- 15.de Vries E, Bray FI, Coebergh JW, Parkin DM. Changing epidemiology of malignant cutaneous melanoma in Europe 1953-1997: Rising trends in incidence and mortality but recent stabilizations in western Europe and decreases in Scandinavia. Int J Cancer 2003;107:119–126. doi: 10.1002/ijc.11360. [DOI] [PubMed] [Google Scholar]
- 16.Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (Keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol 2015;151:1081–1086. doi: 10.1001/jamadermatol.2015.1187. [DOI] [PubMed] [Google Scholar]
- 17.Little EG, Eide MJ. Update on the current state of melanoma incidence. Dermatol Clin 2012;30:355–361. doi: 10.1016/j.det.2012.04.001. [DOI] [PubMed] [Google Scholar]
- 18.Cakir BÖ, Adamson P, Cingi C. Epidemiology and economic burden of nonmelanoma skin cancer. Facial Plast Surg Clin North Am 2012;20:419–422. doi: 10.1016/j.fsc.2012.07.004. [DOI] [PubMed] [Google Scholar]
- 19.Housman TS Feldman SR Williford PM Fleischer AB Jr. Goldman ND Acostamadiedo JM, et al. Skin cancer is among the most costly of all cancers to treat for the Medicare population. J Am Acad Dermatol 2003;48:425–429. doi: 10.1067/mjd.2003.186. [DOI] [PubMed] [Google Scholar]
- 20.Paulson KG Gupta D Kim TS Veatch JR Byrd DR Bhatia S, et al. Age-specific incidence of melanoma in the United States. JAMA Dermatol 2020;156:57–64. doi: 10.1001/jamadermatol.2019.3353. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Danysh HE, Navai SA, Scheurer ME, Hunt R, Venkatramani R. Malignant melanoma incidence among children and adolescents in Texas and SEER 13, 1995-2013. Pediatr Blood Cancer 2019;66:e27648. doi: 10.1002/pbc.27648. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Pruthi DK, Guilfoyle R, Nugent Z, Wiseman MC, Demers AA. Incidence and anatomic presentation of cutaneous malignant melanoma in central Canada during a 50-year period: 1956 to 2005. J Am Acad Dermatol 2009;61:44–50. doi: 10.1016/j.jaad.2009.01.020. [DOI] [PubMed] [Google Scholar]
- 23.Olsen CM, Thompson JF, Pandeya N, Whiteman DC. Evaluation of sex-specific incidence of melanoma. JAMA Dermatol 2020;156:553–560. doi: 10.1001/jamadermatol.2020.0470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Wong JR, Harris JK, Rodriguez-Galindo C, Johnson KJ. Incidence of childhood and adolescent melanoma in the United States: 1973-2009. Pediatrics 2013;131:846–854. doi: 10.1542/peds.2012-2520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Yang DD Borsky K Jani C Crowley C Rodrigues JN Matin RN, et al. Trends in keratinocyte skin cancer incidence, mortality and burden of disease in 33 countries between 1990 and 2017. Br J Dermatol 2023;188:237–246. doi: 10.1093/bjd/ljac064. [DOI] [PubMed] [Google Scholar]
- 26.Olsen CM Wilson LF Green AC Bain CJ Fritschi L Neale RE, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. Aust N Z J Public Health 2015;39:471–476. doi: 10.1111/1753-6405.12470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Sánchez G Nova J Rodriguez-Hernandez AE Medina RD Solorzano-Restrepo C Gonzalez J, et al. Sun protection for preventing basal cell and squamous cell skin cancers. Cochrane Database Syst Rev 2016;7:CD011161. doi: 10.1002/14651858.CD011161.pub2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Demircan C, Elcin G. An observational study comparing the number, the localization and the dermoscopic patterns of melanocytic nevi in cutaneous melanoma and basal cell carcinoma patients. Indian J Dermatol 2023;68:587. doi: 10.4103/ijd.ijd_549_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Wei EX, Li X, Nan H. Extremity nevus count is an independent risk factor for basal cell carcinoma and melanoma, but not squamous cell carcinoma. J Am Acad Dermatol 2019;80:970–978. doi: 10.1016/j.jaad.2018.09.044. [DOI] [PubMed] [Google Scholar]
- 30.Wu S, Cho E, Li WQ, Qureshi AA. History of keratinocyte carcinoma and risk of melanoma: A prospective cohort study. J Natl Cancer Inst 2017;109:djw268. doi: 10.1093/jnci/djw268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Diepgen TL, Mahler V. The epidemiology of skin cancer. Br J Dermatol 2002;146(Suppl 61):1–6. doi: 10.1046/j.1365-2133.146.s61.2.x. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.