Global, regional, and national trends in the burden of melanoma and non-melanoma skin cancer: insights from the global burden of disease study 1990–2021

Abstract

This study examines global, regional, and national trends in melanoma and non-melanoma skin cancer (NMSC) burden from 1990 to 2021, their socioeconomic associations, and projects future trends. Data was extracted from the Global Burden of Disease (GBD) 2021 database, focusing on malignant melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Joinpoint regression, age-period-cohort modeling, and decomposition analysis were used to assess temporal trends. The Socio-Demographic Index (SDI) was applied to examine the correlation between skin cancer burden and socioeconomic development, and ARIMA models forecasted future trends. The global burden of skin cancers has shown significant growth over the study period, with the age-standardized incidence rate (ASIR) rising globally (Estimated Annual Percentage Change, EAPC = 1.94%) from 1990 to 2021. This increase was particularly pronounced for BCC and SCC, while the melanoma DALYs rate declined (EAPC = -0.67%). In 2021, the most recent year covered, the global incidence of skin cancers was 6.64 million cases, with an ASIR of 77.66 per 100,000 and a disability-adjusted life years (DALYs) burden of 2.89 million cases. Significant geographic disparities were observed, with Australasia and North America reporting the highest ASIR, while middle-SDI regions exhibited rapid increases. Skin cancer incidence is rising globally, driven by demographic changes, increased UV exposure, and improved detection. The burden of melanoma has decreased, which may be related to advances in treatment. Targeted prevention, equitable access to care, and tailored regional strategies are crucial to mitigating the growing impact of skin cancers worldwide.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-90485-3.

Introduction

Skin cancer, comprising malignant melanoma and non-melanoma skin cancers (NMSC), has emerged as one of the most significant and growing public health challenges worldwide^1,2. Together, these cancers impose a substantial burden on global health systems. Malignant melanoma, though accounting for a smaller proportion of skin cancer cases, is highly lethal and responsible for the majority of skin cancer-related deaths, making it a critical focus for healthcare interventions³. In contrast, NMSC, predominantly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), represents the most commonly diagnosed malignancy globally, often requiring extensive healthcare resources due to its high incidence and recurrence rates⁴. Driven by an aging population, greater UV exposure, and improved awareness enhancing early diagnosis, the incidence of melanoma and NMSC has shown a consistent upward trend. This growing burden underscores their dual impact, collectively presenting a multifaceted challenge for healthcare systems worldwide.

There are notable disparities in the incidence and burden of skin cancers across regions and countries, largely influenced by environmental and population factors. High-income regions, such as North America and Australasia, consistently report the highest age-standardized incidence rates, driven by fair-skinned populations with lower melanin levels that provide less natural protection against ultraviolet (UV) radiation. Additionally, these regions experience higher overall UV exposure due to outdoor lifestyles, geographic proximity to the equator, and environmental factors such as ozone depletion^5,6. In contrast, less developed regions are witnessing a growing burden of skin cancers, with increased UV exposure exacerbated by urbanization and climate-related changes⁷. Despite relatively lower incidence rates, populations in these regions often face more severe outcomes due to delayed diagnoses and limited access to protective measures, such as sunscreen and public education.

Economic and social factors further contribute to the disparities in the burden of skin cancers. In high-income regions, while advanced healthcare systems improve early detection and treatment outcomes, the burden is compounded by the rising costs of diagnosis, treatment, and long-term management. For example, the United States spends approximately $4.8 billion annually on NMSC and $3.3 billion on melanoma, highlighting the economic strain of high incidence rates⁸. Conversely, low- and middle-income countries struggle with systemic barriers, including insufficient medical resources, inadequate public health campaigns, and limited access to sunscreen and protective clothing. These challenges hinder the development of effective prevention strategies, leading to higher rates of advanced-stage presentations and poorer outcomes. Addressing these disparities requires targeted public health interventions that account for regional differences in economic and social contexts, ensuring equitable access to prevention and care worldwide.

The Global Burden of Disease (GBD) study is a comprehensive, multi-dimensional framework that assesses the impact of diseases and injuries on global health, covering a wide range of health conditions beyond skin cancers, including cancers, infectious diseases, and non-communicable diseases. The study provides valuable data on the incidence, prevalence, and burden of diseases, offering insights into health trends and disparities^9,10. In this study, we utilized the GBD 2021 data to investigate the global and regional burden of melanoma and non-melanoma skin cancers, providing a broad perspective on the epidemiology of these diseases. This study systematically examines the incidence and disability-adjusted life years (DALYs) of malignant melanoma and NMSC across different age groups, and socioeconomic levels from 1990 to 2021, spanning 204 countries and territories. It also explores the link between skin cancer burden and the Socio-Demographic Index (SDI), providing insights into how development levels shape the epidemiology of skin cancers. Using predictive modeling, this study estimates future trends in skin cancer burden, offering critical evidence for decision-making. These findings aim to guide the development of targeted prevention, screening, and treatment strategies, supporting policymakers and healthcare providers in addressing the growing global challenge of skin cancer effectively and equitably.

Methods

Data sources

The Global Burden of Disease (GBD) study is a comprehensive, systematic effort to quantify the incidence, prevalence, and burden of diseases globally. It provides a framework for assessing health metrics across 204 countries and territories, allowing for comparisons of health outcomes across regions, time periods, and demographic groups^9,10. The analysis focused on three major skin cancers—malignant skin melanoma, basal-cell carcinoma (BCC), and squamous-cell carcinoma (SCC)—which represent the most clinically significant and burdensome forms of skin cancer. These cancers were identified using the International Classification of Diseases (ICD) codes C43-C43.9 and C44-C44.9. Other types of skin cancers, such as dermatofibrosarcoma protuberans and cutaneous lymphomas, were not included in the GBD 2021 dataset. Data on the incidence and disability-adjusted life years (DALYs) of these cancers, were extracted from the GBD Results Tool (https://vizhub.healthdata.org/gbd-results/). These metrics are available as raw numbers and age-standardized rates per 100,000 population, accompanied by 95% uncertainty intervals (UI), both of which were included in this study. The dataset includes stratified information by age (0–95 years), gender, and geographic region, facilitating detailed subgroup analyses. To assess the relationship between skin cancer burden and socioeconomic development, the Socio-Demographic Index (SDI) was employed. The SDI is a composite metric that ranges from 0 to 1, with higher values representing higher levels of income per capita, average years of schooling, and lower fertility rates. Based on 2021 SDI estimates, countries were grouped into five quintiles: low, low-middle, middle, high-middle, and high. This metric provides a framework to assess how socioeconomic factors influence disease incidence and burden. As this study utilized data from a publicly available database, no ethical approval was needed. Data extraction and analysis strictly adhered to the guidelines provided by the GBD Results Tool and associated documentation.

Joinpoint analysis

To evaluate trends in the global burden of skin cancers, Joinpoint regression analysis was conducted using Joinpoint software (version 5.1.2.0; National Cancer Institute, Rockville, MD, USA). Joinpoint analysis provides a nuanced understanding of how skin cancer burdens have evolved over time, enabling the identification of critical periods for public health intervention¹¹. This method identifies significant changes in trends and estimates the annual percentage change (APC) and average annual percentage change (AAPC) for incidence and DALYs, along with 95% confidence intervals (CI). The model was selected based on the best fit to capture temporal patterns, with AAPC values classified as increasing (CI above zero), decreasing (CI below zero), or stable (CI including zero)¹².

Age-period-cohort analysis

An age-period-cohort model was applied to disentangle the effects of age, period, and birth cohort on skin cancer trends¹³. This approach helps elucidate how generational shifts and aging populations contribute to the observed burden of skin cancers. Age-specific incidence and prevalence data were obtained in 5-year intervals from 1990 to 2021, along with population estimates from the GBD database. The model, fitted using the Epi package (version 2.46) in R (version 4.3.1), utilized Poisson regression to calculate incidence and prevalence rates across age groups, time periods, and birth cohorts. Model selection was guided by residual analysis and the Akaike Information Criterion (AIC)¹⁴.

Decomposition analysis

Decomposition analysis was conducted to evaluate the impacts of aging, population growth, and epidemiological transitions on variations in skin cancer incidence and DALYs. This method calculates the relative impact of each factor by partitioning the observed changes into components attributable to demographic changes (e.g., aging, population growth) and epidemiological changes (e.g., changes in incidence rates). The approach is based on the method described by Das Gupta¹⁵, which has been widely used in demographic and epidemiological studies to disentangle the contributions of different factors to observed trends. This method offers insights into the underlying drivers of temporal trends, aiding the development of precise public health strategies to mitigate the rising burden of skin cancers^16,17.

ARIMA model prediction

To forecast future trends in skin cancer burden, an autoregressive integrated moving average (ARIMA) model was applied. This time series method incorporates historical data to predict near-term trends in incidence and prevalence. ARIMA model parameters (p, d, q) were selected based on performance criteria, such as the AIC and Bayesian Information Criterion (BIC)¹⁸. Stationarity was confirmed using the KPSS test, and residuals were assessed for randomness using the Ljung-Box test. The best-fitting ARIMA model was used to project skin cancer trends over the next decade, providing valuable evidence for planning prevention and treatment strategies¹⁹.

Descriptive analysis and data presentation

Statistical analyses were performed to compare skin cancer burdens across time, regions, and socioeconomic contexts. The Wilcoxon signed-rank test, a non-parametric method, was used to assess differences in skin cancer burdens across years and age groups, accommodating the non-normal distribution of the data. The Kruskal-Wallis H test was employed to compare variations in age-standardized incidence rates (ASIR) and age-standardized DALY rates (ASDR) among the 21 GBD regions and 204 countries and territories, identifying statistically significant disparities. Post-hoc pairwise comparisons with Bonferroni correction were applied where necessary. Pearson’s correlation analysis was conducted to examine the relationship between skin cancer burdens and the SDI, revealing trends influenced by socioeconomic development. All analyses were conducted using R software (version 4.3.1), with statistical significance set at a p-value threshold of < 0.05.

Results

Global, regional, and national burden of overall skin cancers

In 2021, there were an estimated 6,639,951 cases of skin cancers globally, corresponding to an age-standardized incidence rate (ASIR) of 77.66 per 100,000 population. The global burden in terms of disability-adjusted life years (DALYs) reached approximately 2,891,709 cases, with an age-standardized DALYs rate (ASDR) of 33.96 per 100,000 population (Table 1). Significant geographic disparities were observed, with the highest ASIR recorded in High-income North America (730.16) and the United States (813.53), while the highest ASDR was reported in Australasia (141.67), particularly in New Zealand (159.45) (Table 1, Tables S1-S3, Fig. 1A).

Table 1.

Incidence of skin cancers in 1990 and 2021, and their EAPC from 1990 to 2021.

Characteristics	Incidence
	Number of cases, 1990	Age-standardized rate per 100,000 population, 1990	Number of cases, 2021	Age-standardized rate per 100,000 population, 2021	Estimated annual percentage change, 1990–2021
Global	1,785,964 (1,468,745 to 2,133,473)	48.03 (39.76 to 57.35)	6,639,951 (5,876,877 to 7,424,890)	77.66 (68.91 to 86.60)	1.94 (1.54 to 2.35)
Causes
Malignant skin melanoma	124,320 (119,604 to 127,611)	2.98 (2.87 to 3.06)	303,105 (281,718 to 318,905)	3.56 (3.31 to 3.75)	0.65 (0.33 to 0.96)
Non-melanoma skin cancer	1,661,644 (1,349,141 to 2,005,862)	45.04 (36.90 to 54.28)	6,336,846 (5,595,160 to 7,105,985)	74.10 (65.60 to 82.85)	2.02 (1.60 to 2.45)
Basal-cell carcinoma	1,196,532 (982,434 to 1,411,452)	31.67 (26.34 to 37.03)	4,436,939 (3,907,157 to 4,955,955)	51.71 (45.70 to 57.58)	2.01 (1.60 to 2.43)
Squamous-cell carcinoma	465,112 (366,708 to 594,410)	13.38 (10.55 to 17.26)	1,899,907 (1,688,003 to 2,150,030)	22.38 (19.90 to 25.27)	2.06 (1.60 to 2.52)
Sex
Female	850,279 (698,724 to 1,012,931)	41.05 (34.04 to 49.02)	2,782,317 (2,458,445 to 3,113,232)	60.49 (53.47 to 67.58)	1.57 (1.19 to 1.95)
Male	935,684 (765,959 to 1,123,410)	58.51 (48.41 to 70.34)	3,857,633 (3,419,815 to 4,311,762)	99.92 (88.87 to 111.43)	2.17 (1.73 to 2.61)
Socio-demographic Index (SDI)
High SDI	1,415,176 (1,153,258 to 1,703,684)	128.94 (105.89 to 154.66)	5,233,719 (4,710,776 to 5,778,378)	256.81 (230.91 to 282.59)	2.91 (2.42 to 3.40)
High-middle SDI	201,107 (173,130 to 230,553)	20.80 (18.07 to 23.76)	686,675 (565,014 to 814,876)	35.33 (29.20 to 41.72)	0.65 (0.41 to 0.90)
Middle SDI	125,678 (103,742 to 146,411)	12.12 (10.13 to 14.12)	620,104 (494,278 to 737,331)	22.94 (18.48 to 27.18)	1.26 (1.02 to 1.49)
Low-middle SDI	34,555 (27,648 to 41,251)	5.72 (4.65 to 6.79)	77,433 (58,775 to 95,499)	5.24 (4.02 to 6.44)	0.26 (0.10 to 0.42)
Low SDI	8,437 (6,182 to 10,561)	3.43 (2.51 to 4.27)	20,215 (14,721 to 25,452)	3.50 (2.53 to 4.38)	0.03 (0.01 to 0.06)
GBD regions
Andean Latin America	3,420 (3,053 to 3,831)	16.81 (15.04 to 18.79)	7,825 (6,035 to 9,640)	13.16 (10.22 to 16.18)	-0.97 (-1.18 to -0.75)
Australasia	32,677 (26,811 to 39,261)	142.74 (117.81 to 170.72)	64,626 (52,207 to 78,930)	127.75 (103.61 to 154.68)	-0.55 (-0.77 to -0.34)
Caribbean	2,025 (1,597 to 2,430)	7.63 (6.02 to 9.20)	3,636 (2,840 to 4,452)	6.78 (5.29 to 8.30)	-0.54 (-0.63 to -0.45)
Central Asia	11,270 (8,813 to 13,744)	24.23 (19.13 to 29.20)	19,826 (15,105 to 24,613)	24.37 (19.02 to 29.61)	0.01 (-0.02 to 0.03)
Central Europe	41,967 (37,210 to 47,152)	28.70 (25.59 to 32.20)	76,909 (62,996 to 93,151)	36.00 (29.51 to 43.05)	1.05 (0.85 to 1.26)
Central Latin America	25,363 (20,038 to 30,329)	29.97 (24.04 to 36.03)	76,072 (60,080 to 92,078)	30.36 (24.26 to 36.74)	0.05 (0.04 to 0.06)
Central Sub-Saharan Africa	1,190 (874 to 1,515)	5.07 (3.76 to 6.37)	3,100 (2,264 to 3,993)	5.13 (3.79 to 6.52)	0.05 (0.02 to 0.07)
East Asia	43,412 (34,121 to 52,265)	4.89 (3.95 to 5.88)	806,098 (649,114 to 959,400)	36.93 (30.25 to 43.62)	4.42 (3.67 to 5.18)
Eastern Europe	55,003 (44,680 to 66,192)	20.15 (16.54 to 24.12)	91,507 (74,626 to 111,053)	26.97 (21.93 to 32.34)	0.98 (0.92 to 1.04)
Eastern Sub-Saharan Africa	4,110 (3,035 to 5,076)	4.96 (3.64 to 6.12)	9,956 (7,137 to 12,768)	5.01 (3.55 to 6.38)	-0.02 (-0.03 to -0.01)
High-income Asia Pacific	7,702 (6,423 to 9,096)	3.95 (3.31 to 4.64)	26,938 (22,186 to 32,379)	6.21 (5.14 to 7.33)	1.45 (1.38 to 1.51)
High-income North America	1,168,663 (933,936 to 1,423,378)	332.52 (266.50 to 403.33)	4,731,124 (4,279,928 to 5,203,539)	730.16 (660.78 to 801.20)	3.38 (2.78 to 3.99)
North Africa and Middle East	29,852 (23,527 to 35,953)	17.52 (14.06 to 20.97)	82,240 (58,407 to 100,728)	17.83 (12.78 to 21.91)	0.05 (-0.27 to 0.36)
Oceania	17 (10 to 30)	0.47 (0.31 to 0.81)	42 (26 to 69)	0.46 (0.30 to 0.75)	-0.01 (-0.03 to 0.01)
South Asia	21,214 (15,615 to 27,683)	3.24 (2.39 to 4.16)	58,766 (43,314 to 76,491)	3.70 (2.74 to 4.76)	0.45 (0.41 to 0.48)
Southeast Asia	6,776 (5,729 to 8,123)	2.61 (2.22 to 3.10)	12,837 (9,458 to 16,536)	1.97 (1.48 to 2.51)	-0.83 (-1.13 to -0.54)
Southern Latin America	12,350 (10,592 to 14,129)	27.00 (23.26 to 30.74)	24,114 (19,366 to 29,448)	27.90 (22.30 to 33.93)	0.14 (0.06 to 0.21)
Southern Sub-Saharan Africa	6,519 (5,032 to 8,042)	23.02 (17.59 to 28.56)	17,783 (13,390 to 22,104)	29.73 (22.34 to 36.82)	0.28 (-0.22 to 0.78)
Tropical Latin America	64,134 (55,757 to 71,940)	68.65 (60.02 to 77.00)	111,205 (91,225 to 131,786)	42.81 (35.24 to 50.46)	-0.09 (-0.55 to 0.38)
Western Europe	270,536 (241,886 to 302,749)	48.53 (43.55 to 53.93)	477,783 (392,911 to 574,466)	55.58 (46.23 to 65.90)	0.56 (0.35 to 0.78)
Western Sub-Saharan Africa	3,298 (2,379 to 4,145)	3.40 (2.43 to 4.26)	8,067 (5,553 to 10,250)	3.47 (2.42 to 4.36)	0.06 (0.05 to 0.07)

EAPC estimated annual percentage change.

Fig. 1.

Global and regional burden of skin cancers in 2021 and trends from 1990 to 2021. (A) Age-standardized incidence rates (ASIR) and age-standardized DALY rates (ASDR) for overall skin cancers, malignant melanoma, basal-cell carcinoma (BCC), and squamous-cell carcinoma (SCC) in 2021 across global and regional levels. (B) Estimated annual percentage changes (EAPC) in ASIR and ASDR for skin cancers from 1990 to 2021 globally and by region. Error bars show 95% uncertainty intervals.

From 1990 to 2021, the global ASIR of skin cancers exhibited a steady increase, with an estimated annual percentage change (EAPC) of 1.94%. This growth was particularly pronounced in East Asia (EAPC = 4.42), with China (4.47) showing the most rapid increase at the national level (Table 1, Table S2, Fig. 2C). Conversely, the global ASDR showed a slight decrease (EAPC = -0.32%), indicating improved management and treatment outcomes over time. However, this decline was not consistent across all regions; several less economically developed areas, such as Southern Sub-Saharan Africa (EAPC = 1.10), Caribbean (EAPC = 0.91), and Andean Latin America (EAPC = 0.80), exhibited rising ASDR (Table 1; Figs. 1B and 2A,B). At the country level, Egypt (EAPC = 5.95) had the most significant increase in ASDR (Table S1-S3, Fig. 2D).

Fig. 2.

Global distribution and trends in the burden of overall skin cancers. (A) ASIR of overall skin cancers per 100,000 population in 2021. (B) ASDR of overall skin cancers per 100,000 population in 2021. (C) EAPC in ASIR of overall skin cancers from 1990 to 2021. (D) EAPC in ASDR of overall skin cancers from 1990 to 2021.

The Joinpoint regression analysis revealed varying temporal trends across different types of skin cancers. Between 2000 and 2004, the ASIR of overall skin cancers saw the most pronounced growth (APC = 10.92), primarily driven by sharp increases in basal-cell carcinoma and squamous-cell carcinoma during this period. From 2019 to 2021, a slower but consistent rise in ASIR was observed (APC = 1.8). In contrast, malignant melanoma demonstrated moderate increases throughout the study period (Fig. 3A). In terms of burden, global ASDR for overall skin cancers declined from 2014 to 2021 (APC = -1.51), primarily due to significant reductions in malignant melanoma (APC = -2.08). The ASDR for BCC and SCC remained largely stable during this period (Fig. 3B).

Fig. 3.

Temporal trends in the burden of skin cancers from 1990 to 2021. (A) ASIR trends of overall skin cancers, malignant melanoma, BCC, and SCC. (B) ASDR trends of overall skin cancers, malignant melanoma, BCC, and SCC.

Regional disparities in the burden of three main skin cancers

In 2021, the global burden of the three main skin cancers—malignant melanoma, basal-cell carcinoma, and squamous-cell carcinoma—demonstrated substantial variation in incidence and DALYs. The global numbers of new cases were 303,105 for malignant melanoma, 4,436,939 for BCC, and 1,899,907 for SCC, corresponding to ASIR of 3.56, 51.71, and 22.38 per 100,000 population, respectively. The associated global DALYs were 1,678,836 (19.63 per 100,000 population) for malignant melanoma, 1998 (0.02 per 100,000 population) for BCC, and 1,210,875 (14.31 per 100,000 population) for SCC (Fig. 1A). Regionally, High-income North America, East Asia, and Western Europe reported the highest numbers of new cases and DALYs for these cancers (Fig. 4A and B). Globally, BCC constituted the largest proportion of all incident cases (66.82%), followed by SCC (28.61%) and malignant melanoma (4.56%) (Fig. 4C). However, malignant melanoma accounted for the majority of DALYs (58.06%), reflecting its higher mortality burden compared to non-melanoma skin cancers, followed by SCC (41.87%) and BCC (0.07%) (Fig. 4D).

Fig. 4.

Cross-sectional and longitudinal burden of skin cancers in 2021. (A) Number of new cases of malignant melanoma, BCC, and SCC by region. (B) Number of DALYs attributed to malignant melanoma, BCC, and SCC by region. (C) Proportion of incident cases for each skin cancer type (malignant melanoma, BCC, SCC) globally and by region. (D) Proportion of DALY burden for each skin cancer type by region.

At the regional level, the highest ASIR in 2021 were observed in Australasia for malignant melanoma (32.40 per 100,000 population), and in High-income North America for both BCC (473.14 per 100,000 population) and SCC (240.41 per 100,000 population) (Fig. 1A and S1A–S3A). Regarding DALYs, Australasia recorded the highest ASDR for malignant melanoma (109.97 per 100,000 population) and SCC (31.68 per 100,000 population), whereas High-income North America had the highest ASDR for BCC (0.19 per 100,000 population) (Figs. S1B–S3B, Tables S1-S3).

From 1990 to 2021, the global ASIR significantly increased for all three cancers, with EAPC of 0.65 for malignant melanoma, 2.01 for BCC, and 2.06 for SCC. Conversely, trends in DALYs varied: while the global ASDR decreased for malignant melanoma (EAPC = -0.67), it increased for both BCC (EAPC = 1.64) and SCC (EAPC = 0.24) (Fig. 1B). Among the 21 GBD regions, ASIR increased across 18 regions for malignant melanoma, 10 for BCC, and 12 for SCC. Eastern Europe exhibited the most rapid increase in ASIR for malignant melanoma (EAPC = 2.90), while East Asia had the highest EAPC for both BCC (4.73) and SCC (3.73) (Figs. S2C and S3C). Regarding ASDR, the most significant increases were observed in Eastern Europe for malignant melanoma (EAPC = 0.99), East Asia for BCC (4.26), and Central Asia for SCC (3.30) (Figs. S1B–S3B, Tables S1–S3).

At the national level, New Zealand recorded the highest ASIR and ASDR for malignant melanoma (32.40 and 109.97 per 100,000 population, respectively). For BCC and SCC, the United States reported the highest ASIR (473.14 and 240.41 per 100,000 population, respectively), whereas Australasia recorded the highest ASDR for SCC at 31.68 per 100,000 population (Figs. S1A–S3A). The most significant increases in ASIR and ASDR for malignant melanoma were reported in Mauritius (EAPC = 5.84 and 5.58, respectively). For BCC, China exhibited the steepest rise in ASIR and ASDR (EAPC = 4.78 and 4.32, respectively), while for SCC, the most rapid increases in ASIR and ASDR were observed in China (EAPC = 3.74) and Georgia (EAPC = 13.00), respectively (Figs. S1C–S3D, Tables S1-S3).

Age-group disparities in the burden of three main skin cancers

In 2021, the incidence rates of the three main skin cancers increased with age, with basal-cell carcinoma and squamous-cell carcinoma peaking in the 50–69 years age group. Malignant melanoma incidence rates, however, demonstrated a continuous increase across all age groups without a plateau (Fig. 5A). In terms of DALY rates, both malignant melanoma and squamous-cell carcinoma exhibited a steady upward trend with increasing age, whereas basal-cell carcinoma peaked at 50–59 years before declining in the oldest age groups (Fig. 5B). Among all age groups, the highest number of incident cases was observed for basal-cell carcinoma, followed by squamous-cell carcinoma and malignant melanoma. Conversely, in terms of DALYs, squamous-cell carcinoma accounted for the highest burden, followed by malignant melanoma, while basal-cell carcinoma contributed the least.

Fig. 5.

Age-specific incidence, DALYs, and percentage changes in skin cancers. (A) Number of new cases and ASIR of malignant melanoma, BCC, and SCC across different age groups in 2021. (B) Number of DALYs and ASDR across age groups in 2021. (C) Percentage changes in incidence rates of overall skin cancers and individual cancer types from 1990 to 2021. (D) Percentage changes in DALYs rates of overall skin cancers and individual cancer types from 1990 to 2021.

From 1990 to 2021, the percentage change in incidence rates for basal-cell carcinoma, squamous-cell carcinoma, and overall skin cancers exhibited an increasing trend with age, peaking between the 60–79 years age groups, followed by a decline in the oldest populations (Fig. 5C). In contrast, malignant melanoma showed consistent percentage increases in incidence across most age groups, with a pronounced upward trend in older populations. Similarly, percentage changes in DALY rates for malignant melanoma and squamous-cell carcinoma demonstrated a steady upward trend across age groups, whereas basal-cell carcinoma showed a peak in the 50–59 years age group, followed by a decline (Fig. 5D).

From an age-period-cohort perspective, ASIR and ASDR increased consistently with age, plateauing in the oldest age groups (Figs. S4A,B, S5A,B). Successive birth cohorts exhibited progressively higher rates of ASIR and ASDR, reflecting a growing burden of skin cancers in more recent generations (Figs. S4C,D, S5C,D). These patterns highlight the disproportionate burden of malignant melanoma, basal-cell carcinoma, and squamous-cell carcinoma among middle-aged and older populations, with the greatest impact observed in the 50–79 years age group.

Burden of skin cancers according to socio-demographic index (SDI)

Between 1990 and 2021, a positive correlation was observed between the ASIR of skin cancers and the SDI across the 21 GBD regions. For basal-cell carcinoma and squamous-cell carcinoma, the ASIR steadily increased with higher SDI levels. However, for malignant melanoma, the ASIR initially rose but began to decline when the SDI exceeded 0.8 (i.e., when socioeconomic development was at a high level). These trends highlight differential patterns in skin cancer incidence across development levels (Fig. 6A–D). Similarly, the ASDR of malignant melanoma and SCC initially increased with rising SDI but started declining at SDI values around 0.75. In contrast, the ASDR for BCC showed a consistent increase with higher SDI levels, reflecting its low mortality burden (Fig. 6E–H).

Fig. 6.

Correlation between Socio-Demographic Index (SDI) and the burden of skin cancers. (A–D) ASIR of overall skin cancers, malignant melanoma, BCC, and SCC in relation to SDI. (E–H) ASDR of overall skin cancers, malignant melanoma, BCC, and SCC in relation to SDI. Shaded areas indicate 95% CI.

At the national level in 2021, the ASIR of overall skin cancers was positively correlated with SDI (R = 0.29, p < 0.001), driven primarily by trends in BCC and SCC. However, the ASIR of malignant melanoma displayed a non-linear relationship, peaking in countries with SDI values around 0.8 and declining in higher-SDI nations, such as the United States and Australia (Figs. S6–S9). Similarly, the ASDR for overall skin cancers correlated with SDI (R = 0.46, p < 0.001), with malignant melanoma contributing the largest share of the disease burden in higher-SDI regions (Figs. S6 and S7).

Between 1990 and 2021, the EAPC of skin cancer incidence and DALYs demonstrated complex relationships with SDI. For overall skin cancers, the EAPC of ASIR increased modestly with SDI, particularly for BCC and SCC. For malignant melanoma, the EAPC of ASIR rose with increasing SDI but plateaued in very high-SDI countries. In contrast, the EAPC of ASDR for malignant melanoma and SCC showed slight declines at higher SDI levels. For BCC, the EAPC of ASDR remained stable across SDI levels, reflecting its low contribution to overall mortality (Figs. S6–S9).

Distinct regional and national patterns further emphasize these trends. For instance, in 2021, countries like the United States, New Zealand, and Australia exhibited some of the highest ASIR and ASDR values for malignant melanoma and SCC, aligning with their higher SDI levels. Conversely, regions with lower SDI, such as Sub-Saharan Africa, reported comparatively lower ASIR values, but with increasing EAPC trends, indicating a rising burden (Figs. S6–S9). Notably, countries like Egypt and the Republic of Mauritius displayed rapid increases in both ASIR and ASDR of skin cancers, highlighting the growing impact of skin cancers in middle-SDI nations (Figs. S7 and S8).

Factors influencing and predicted trends of skin cancer burden

The increase in the incidence and DALYs of overall skin cancers from 1990 to 2021 was primarily driven by aging, particularly in high-SDI regions, where aging contributed significantly to both incidence and DALYs (Fig. 7A and B). Population growth played a more critical role in low-SDI regions, where resource constraints and lack of effective prevention strategies exacerbate the disease burden. For malignant melanoma and basal-cell carcinoma, aging was the dominant factor influencing the increase in high- and high-middle SDI regions (Figs. S10 and S11). In contrast, population growth was the major contributor to the increased burden in low-SDI regions. Squamous-cell carcinoma displayed a more balanced contribution from aging and epidemiological changes, particularly in middle- and high-middle SDI regions, while population growth remained significant in low-SDI regions (Fig. S12).

Fig. 7.

Factors contributing to the burden of overall skin cancers across SDI quintiles. (A) Contributions of aging, epidemiological changes, and population growth to the number of incident cases of overall skin cancers across SDI quintiles. (B) Contributions of the same factors to the number of DALYs attributed to overall skin cancers across SDI quintiles. The black dots represent the total values for each SDI group.

Using the ARIMA model, the age-standardized incidence rate (ASIR) of overall skin cancers is projected to rise from 77.66 per 100,000 in 2021 to 101.73 per 100,000 in 2030 (Fig. 8A). This increase is primarily attributed to basal-cell carcinoma and squamous-cell carcinoma. While the ASIR of malignant melanoma is expected to increase at a slower rate, its burden remains substantial. The ASDR of overall skin cancers, however, is projected to slightly decline from 33.96 per 100,000 in 2021 to 32.40 per 100,000 in 2030 (Fig. 8B).

Fig. 8.

Forecast of ASIR and ASPR of skin cancers (1990–2030). Trends in (A) age-standardized incidence rates (ASIR) and (B) age-standardized DALYs rates (ASDR) of skin cancers. Shaded areas indicate the forecast interval for 2022–2030.

Discussion

This study examines the global and regional burden of skin cancers, including malignant melanoma and non-melanoma skin cancers (BCC and SCC), using data from the Global Burden of Disease (GBD) 2021 study. Our findings reveal that skin cancer incidence is rising globally, with significant regional disparities. High-income countries, particularly in Australasia and North America, report the highest incidence rates, while middle-income regions such as East Asia and Central Latin America are experiencing rapid increases. While melanoma incidence rates have steadily increased, the burden of melanoma-related DALYs has declined due to advances in treatment. Conversely, non-melanoma skin cancers, particularly BCC and SCC, continue to contribute significantly to the overall burden, with notable increases in both incidence and DALYs, especially in rapidly industrializing regions. The findings highlight the complex interplay of demographic, environmental, and healthcare factors driving these trends.

The rising global ASIR of melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) are attributable to various factors. Prolonged ultraviolet (UV) exposure remains the most significant environmental risk factor, particularly in regions with high ambient UV radiation and predominantly fair-skinned populations^20,21. Australasia, with the highest ASIR of melanoma (32.4 per 100,000 in 2021) and SCC, exemplifies this trend, where outdoor lifestyles and inadequate sun protection practices further exacerbate risk^22,23. Behavioral factors, such as the continued use of tanning beds among younger populations, have also been linked to increased melanoma incidence in high-income regions, despite public awareness campaigns²⁴. In contrast, the rising burden in middle-income regions, such as East Asia and Central Latin America, reflects the dual effects of urbanization and improved healthcare infrastructure. Rapid industrialization in middle-income regions has led to increased occupational UV exposure in sectors such as construction, mining, and transportation, while urbanization has reduced access to natural sun protection (e.g., tree cover). Additionally, environmental changes, including ozone depletion and urban heat island effects, may exacerbate UV radiation exposure. At the same time, enhanced diagnostic capabilities, including the widespread adoption of advanced tools like dermoscopy and digital imaging, along with increased public awareness and improved healthcare infrastructure, have significantly contributed to the better reporting and detection of skin cancer cases. For example, the ASIR of SCC in China increased significantly (EAPC = 4.73), highlighting the combined impact of environmental and healthcare system changes^25,26. Emerging factors, such as climate change and ozone depletion, may further exacerbate the global burden of skin cancers. Ozone layer thinning has been associated with increased UV-B radiation, a key driver of melanoma and NMSC^27,28. Additionally, air pollution has been hypothesized to play a role in skin carcinogenesis, with polycyclic aromatic hydrocarbons in polluted air inducing DNA damage and immunosuppression^29,30. Future research should explore these emerging risks to better inform global prevention strategies.

While melanoma and NMSC share UV exposure as a common risk factor, their biological behavior, clinical impact, and associated healthcare challenges differ significantly. Although melanoma is less prevalent than NMSC, it contributes to the majority of skin cancer-related fatalities because of its significant metastatic capacity. High-SDI regions benefit from advanced healthcare systems, facilitating early detection and treatment³¹. Advances in immunotherapy (e.g., PD-1 inhibitors like nivolumab) and targeted therapy (e.g., BRAF and MEK inhibitors) have significantly improved survival rates, particularly in high-income regions where these treatments are widely available^32–34. However, in low-SDI regions, limited access to these therapies and delayed diagnoses contribute to high mortality rates, as seen in Sub-Saharan Africa and Egypt (EAPC = 5.95 in ASDR). Early detection remains critical, as survival rates drop dramatically with advanced-stage diagnoses. BCC is the most common skin cancer globally, characterized by low mortality but significant morbidity due to its potential for local invasion and recurrence. High-income countries report the greatest burden of BCC, where early detection and treatment are facilitated by robust healthcare systems. Despite its low DALYs contribution, BCC imposes substantial healthcare costs due to surgical excision and follow-up care³⁵. Public health efforts should prioritize minimizing unnecessary healthcare burdens through targeted prevention strategies, such as sun protection campaigns. SCC has a higher mortality risk compared to BCC and contributes disproportionately to DALYs, particularly in regions with high UV exposure. Unlike BCC, SCC is more likely to metastasize, posing greater challenges for management⁷. Middle-SDI regions, such as Central Asia, have experienced rapid increases in SCC burden (EAPC = 3.73 for ASIR), driven by aging populations, occupational UV exposure, and limited preventive measures³⁶. These findings emphasize the need for region-specific strategies to address SCC, including workplace safety regulations and improved access to dermatological care.

The projected rise in global ASIR, particularly for BCC and SCC, underscores the impact of population aging. From an age-period-cohort perspective, ASIR and ASDR increased consistently with age, highlighting the disproportionate burden of skin cancers among older populations, emphasizing the need for targeted prevention and early detection efforts to mitigate the disease burden in these age groups. Older individuals are more susceptible to skin cancers due to cumulative UV exposure and declining immune surveillance^37,38. In high-income countries, increased longevity further contributes to the observed rise in incidence rates, as the risk of skin cancer increases with age. The ARIMA model predicts a significant increase in ASIR by 2030, driven primarily by aging populations in high- and middle-income regions. While improvements in diagnostic capabilities will likely contribute to these trends, they also present opportunities for earlier detection and intervention. For melanoma, the predicted modest increase in ASIR alongside declining ASDR suggests that advancements in treatment may continue to mitigate disease burden. However, the effectiveness of these interventions may be undermined by behavioral trends, such as inadequate sun protection practices, and emerging environmental risks. Strengthening primary prevention, including public education and sun safety campaigns, remains critical to offsetting these trends^39,40.

This study has several limitations. First, data imbalances in low-SDI regions may lead to underestimations of skin cancer burden. Second, NMSC, particularly BCC, is often underreported, as many countries do not include it in cancer registries. Third, this study is limited to examining the burden of three predominant skin cancers—melanoma, basal cell carcinoma, and squamous cell carcinoma—without addressing rarer or less-studied skin cancer types. Fourth, the ARIMA model used for projections may not fully account for future advancements in prevention or treatment. Lastly, the reliance on DALYs as a burden metric may overlook the psychological and economic impacts of recurrent NMSC. Future studies should address data imbalances in low-SDI regions and improve reporting of NMSC, particularly BCC, through enhanced cancer registries. Expanding research to include rare skin cancers and refining predictive models to account for emerging factors will provide a more comprehensive understanding. Additionally, integrating metrics beyond DALYs to capture psychological and economic impacts can better reflect the true burden of skin cancers.

The rising burden of melanoma and NMSC highlights the complex interplay of environmental, demographic, and healthcare factors. While therapeutic advancements have significantly improved melanoma outcomes, the increasing incidence of all skin cancers underscores the need for robust prevention and early detection efforts. Regional and socioeconomic disparities call for tailored public health interventions, emphasizing equitable access to care, targeted prevention, and region-specific strategies to mitigate the growing global burden of skin cancers.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

LZ conducted the data analysis and manuscript writing; LZ, YZ and LH undertook the paper revision and data organization. YX and MJW provided general guidance and suggested revisions. All authors reviewed the manuscript.

Funding

This work was supported by National natural science foundation of China (No.82303988, 82273558) and National key research and development program (2022YFC2504700).

Data availability

The datasets analyzed in this study are publicly available and can be accessed at: https://ghdx.healthdata.org/gbd-2021.

Declarations

Competing interests

The authors declare no competing interests.

Ethics statement

This study utilized data from the Global Burden of Disease (GBD) study, which does not require patient informed consent. The research adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) in population health research.

Consent for publication

All authors have reviewed and approved the final version of the manuscript for publication.