“Get Data Out” Skin: national cancer registry incidence and survival rates for all registered skin tumour groups for 2013-2019 in England

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 English tumours between 2013-19. Method 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 and tumours of uncertain malignant potential. Second level groups split skin cancer into keratinocyte cancer (KC), melanoma and rare cancers. Third level split KC into basal cell carcinoma (BCC) and squamous cell carcinoma (cSCC). Further groups were split into genital or non-genital, first or subsequent, age, gender, stage, or NHS (National Health Service) 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 1,445,377 skin cancers and 49,123 precancerous lesions and undefined entities were registered in England between 2013-19. 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 (PY) (95% confidence interval (CI): 280.98 - 283.76, n=158,934) in 2019, followed by cSCC with 85.24 per 100,000 PY (95% CI: 84.48 - 86.00, n=47,977) and melanoma with 27.24 (95% CI: 26.81 - 27.67, n= 15,332) per 100,000 PY. Each year approximately 1,800 rare skin cancers, 1,500 genital cSCC and 100 extramammary Paget disease are registered. Of 15,000 melanoma there are 120 cases of melanoma in under 25s yearly. 1-year and 5-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 melanoma’s (89.6% (95% CI: 88.7 -90.6)). BCC had excellent survival (overall net survival >100%). Patients with late-stage melanoma, Merkel cell carcinoma and genital cSCC have a 5-year net survival below 60%. Older patients received fewer TWW referrals than their young 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. Conclusion GDO (Get Data Out) skin provides detailed and up-to-date statistics on all registrable skin tumours in England, including for the first time pre-cancerous 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.