‘Get Data Out’ Skin: national cancer registry incidence and survival rates for all registered skin tumour groups for 2013–2019 in England
Authors: van Bodegraven Birgitta , Vernon Sally , Eversfield Charlotte , Board Ruth , Craig Paul  , Gran Sonia , Harwood Catherine A , Keohane Stephen , Levell Nick J , Matin Rubeta N   , Proby Charlotte , Rajan Neil , Rous Brian , Ascott Anna , Millington George W M , Venables Zoe C ,   the British Association of Dermatologists National Disease Registration Service Steering Committee, van Bodegraven Birgitta , Proby Charlotte , Millington George , Morrison Simon , Gran Sonia , Warren Richard , Ascott Anna , Ahmed Shehnaz , Paley Lizz , Venables Zoe , Vernon Sally 
Published: February 2023

Abstract

Background
Providing detailed skin cancer statistics, including incidence and survival, by tumour type and patient characteristics is important for up-to-date epidemiological information.

Objectives
To create a new clinically relevant consensus-based classification for registered skin tumours using tumour type and patient characteristics and to describe its application to all registered tumours in England between 2013 and 2019.

Methods
Tumours with skin topographical codes (ICD-10) and morphology and behaviour (ICD-O3) were grouped together in an iterative process creating a hierarchical tree structure. The primary-level grouping partitioned skin tumours into skin cancer, melanoma in situ, extramammary Paget disease (EMPD) and tumours of uncertain malignant potential. Second-level groups split skin cancer into keratinocyte cancer (KC), melanoma and rare cancers. The third-level group split KC into basal cell carcinoma (BCC) and squamous cell carcinoma (cSCC). Further groups were split into genital or non-genital, first or subsequent tumour, age, gender, stage, or National Health Service (NHS) region. Incidence counts, Kaplan–Meier and net survival estimates and referral routes [two-week wait (TWW), general practitioner (GP), outpatient] categorisations were calculated for each grouping across all years.

Results
A total of 1 445 377 skin cancers and 49 123 precancerous lesions and undefined entities were registered in England between 2013 and 2019. Skin tumours and skin cancer incidence rates are increasing for most tumour types. The most common type of skin cancer was BCC with an incidence rate of 282.36 per 100 000 person-years (PYs) [n = 158 934, 95% confidence interval (CI) 280.98–283.76] in 2019, followed by cSCC with an incidence rate of 85.24 per 100 000 PYs (n = 47 977, 95% CI 84.48–86.00) and melanoma with 27.24 (n = 15 332, 95% CI 26.81–27.67) per 100 000 PYs. Each year approximately 1800 rare skin cancers, 1500 genital cSCCs and 100 cases of EMPD are registered. Of 15 000 melanoma cases, 120 cases of melanoma occur in individuals aged &lt; 25 years annually. One-year and five-year overall net survival varies by tumour type. cSCC 5-year net survival (89.8%, 95% CI 88.8–90.9) was comparable to the net survival of all melanomas (89.6%, 95% CI 88.7–90.6). BCC had excellent survival (overall net survival &gt; 100%). Patients with late-stage melanoma, Merkel cell carcinoma and genital cSCC have a 5-year net survival &lt; 60%. Older patients received fewer TWW referrals than their younger counterparts with the same tumour type at the same location. Patients with acral lentiginous melanoma had fewer TWW referrals and more standard GP referrals than patients with common melanomas.

Conclusions
‘Get Data Out’ Skin provides detailed and up-to-date statistics on all registrable skin tumours in England, including for the first time precancerous lesions and rare subtypes of common cancers. These data can be used by clinicians, researchers and commissioners to better understand skin cancer and improve resource allocation.