In March 2020, specialty healthcare global business provider, Sanofi Genzyme, asked 3,638 British adults what they knew about non-melanoma skin cancers (NMSC), including basal cell carcinoma (BCC) squamous cell carcinoma (SCC) and other, rarer sub-types.[i]
The responses to this survey were used to create a report, published on 9 July, called: STATE OF THE NATION: NON-MELANOMA SKIN CANCER.
In the foreword to the Report, Chair of the All-Party Parliamentary Group (APPG) on Skin, Sir Edward Leigh MP, cited a research letter [Goon et al (2017)[ii]] which predicted that there would be around 400,000 NMSC cases-per-year by 2025, as a means to emphasise the publication’s most significant findings:
‘For the first time, this report shows a picture of outstanding need in NMSC. It provides a benchmark for the current state of the nation in NMSC and identifies opportunities to help improve all aspects of a patient’s care. Challenges highlighted within the report include the low levels of current understanding and awareness of NMSC amongst the public, continuing shortfall in the workforce that are able and equipped to diagnose and manage NMSC, and the significant outstanding gaps in our understanding of its scale and the quality of care offered to those diagnosed.
Ultimately, we hope that through the publication of this report, action on NMSC will be taken by policy makers and service commissioners across the UK. The scale and increasing burden of NMSC means that we can ill afford to postpone these actions’.
NMSC, as we have discussed on numerous occasions in BC Disease News articles, is the most common type of cancer diagnosed in the UK, [iii] with the biggest risk factor being over-exposure to the sun’s ultraviolet (UV) rays.[iv]
The latest Cancer Research UK data on NMSC (last reviewed 5 March 2020) shows that between 2015 and 2017, there were, on average, 151,739 new cases each year (almost doubling the number of NMSC cases recorded in the previous decade).[v]
NMSC develop in the upper layers of the skin and typically occur on head, face and neck areas. Some NMSC can spread to other parts of the body (metastasis) and can be fatal.[vi] Tumours may cause disfigurement, infections and difficulties with hearing, seeing and breathing.[vii] This may lead to psychological issues. When treated (tumour removal surgery), patients are often left with scarring, healing skin grafts and other cosmetic disfiguration, which may have a lasting psychosocial impact.[viii] Patients may also fear the risk of developing more tumours later in life.[ix]
Despite the fact that NMSC has been recognised as an emerging public and occupational health risk, the Sanofi Genzyme survey revealed that:
- 69% did not recognise NMSC as a form of skin cancer.
- 66% thought that the Government could do more to raise awareness of, and help to prevent, NMSC.
- 64% (of workers who spend 1-hour or more outdoors) did not receive assistance from their employer to safeguard against NMSC.
- 58% (of workers who spend 1-hour or more outdoors) would be keen to have more help from their employer to protect them against NMSC.
- 56% did not know that NMSC could spread to other organs in the body.
- 40% could not confidently spot NMSC by the 4 most common signs [(1) a scab or sore that won’t heal, (2) a scaly or crusty patch of skin, (3) a flesh coloured bump that grows, or (4) a ‘volcano-like’ growth].
- 39% would take precautions against NMSC, but only if they were sunbathing.
- 38% did not know what the risk factors of NMSC were.
- 28% would take more precautions if they knew what increased their risk of developing NMSC.
- 23% could correctly identify the 4 most common signs of NMSC (listed in bullet above).
- 15% would apply sunscreen and wear a hat when outside in the sun.
- 13% would take no precautions whatsoever to avoid direct sunlight in the summer months.
In the round, what the survey demonstrated to the Report’s authors was that the potential severity of NMSC is ‘often underestimated’, while the public’s recognition of risk factors, signs and symptoms are ‘worryingly low’. They found this to be ‘particularly concerning’, given the rapid rate of growing NMSC incidence.
What is more, the authors described NMSC issues in the UK workforce as ‘chronic’, with Sir Edward Leigh affirming the ‘major gap that still remains in protecting outdoor workers from NMSC’, especially given that they are at greater risk than the general public.
Indeed, back in edition 229 of BC Disease News (here), we reported that an Industrial Injuries Information Council (IIAC) Information Note had cited a European study, which concluded that outdoor workers, e.g. those in construction and agriculture, doubled their risk of developing skin cancer after 5 or more years of employment.[x]
Making reference to Royal Mail Group’s sun safety strategy, which was last featured in edition 238 (here), the authors stressed that:
‘It is important that all employers of outdoor workers put in place similarly robust measures to reduce the risks of UV exposure to their employees as much as possible’.
Thus, acknowledging that ‘action is needed now’ on NMSC, the Report recommended that policy makers proceed as follows:
- The UK government and all devolved administrations should seek to improve awareness of skin cancer symptoms, including those of NMSC, and promote sun safety measures to prevent skin cancer.
- Employers of outdoor workers should be supported to implement measures that raise awareness of skin cancer among employees and take all possible measures to minimise their risk of exposure. Government should ensure employers are educated and provided with guidance about skin cancer, preventive measures, and psychological support available for workers living beyond skin cancer.
- All patients with NMSC should be provided with access to high-quality information and support to deal with the physical and psychological impacts of the disease and its treatment.
- Governments, health systems and research communities across the UK should work towards improving data and evidence on NMSC.
- Health workforce planning across the UK, including the upcoming NHS People Plan, should recognise the rapidly increasing prevalence of NMSC and plan for the impact that this will have on health systems.
- Skin cancer MDTs should have access to a range of specialisms and competencies, to ensure patients receive the full range of appropriate care options.
[i] ‘STATE OF THE NATION REPORT: NON-MELANOMA SKIN CANCER’ (24 July 2020 Melanoma UK) <https://www.melanomauk.org.uk/news/state-of-the-nation-report-non-melanoma-skin-cancer> accessed 25 August 2020.
Ashleigh Webber, ‘Two-thirds of outdoor workers say firms don’t offer skin cancer protection help’ (10 July 2020 Personnel Today) <https://www.personneltoday.com/hr/two-thirds-of-outdoor-workers-say-firms-dont-offer-skin-cancer-protection-help/> accessed 25 August 2020.
[ii] Goon PKC et al., Predicted cases of U.K. skin squamous cell carcinoma and basal cell carcinoma in 2020 and 2025: horizon planning for National Health Service dermatology and dermatopathology. (2016) British Journal of Dermatology. Volume 176, Issue 5 <https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjd.15110> accessed 25 August 2020.
[iv] Angus J, ‘Diagnosis and management of nonmelanoma skin cancer’ (2017) Therapy Review. Volume 28, Issue 5 <https://trendsinmenshealth.com/wp-content/uploads/sites/23/2017/05/Nonmelanoma-EB-edit-AC-made-lsw-1.pdf> accessed 25 August 2020.
[v] ‘Non-melanoma skin cancer incidence statistics’ (5 March 2020 Cancer Research UK) <https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer/incidence#heading-Zero> accessed 25 August 2020.
[vi] Samarasinghe V and Madan V, Nonmelanoma skin cancer. J Cutan Aesthet Surg. 2012 Jan;5(1):3-10. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339125/epub/> accessed 26 August 2020.
[vii] Burton KA et al., Cutaneous Squamous Cell Carcinoma: A Review of High-Risk and Metastatic Disease. Am J Clin Dermatol. 2016 Oct;17(5):491-508. <https://www.researchgate.net/profile/Kurt_Ashack/publication/303935505_Cutaneous_Squamous_Cell_Carcinoma_A_Review_of_High-Risk_and_Metastatic_Disease/links/577c5dab08aece6c20fcd3b8/Cutaneous-Squamous-Cell-Carcinoma-A-Review-of-High-Risk-and-Metastatic-Disease.pdf> accessed 26 August 2020.
‘Ulcerating Cancer Wounds’ (Macmillan) <https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/ulcerating-cancer-wounds> accessed 26 August 2020
[viii] Lee EH et al., Patient experiences and outcomes following facial skin cancer surgery: a qualitative study. Australas J Dermatol. 2016 Aug; 57(3): e100–e104. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461874/pdf/nihms860290.pdf> accessed 26 August 2020.
[ix] Qureshi AA et al., Host risk factors for the development of multiple non-melanoma skin cancers. J Eur Acad Dermatol Venereol. 2013 May; 27(5): 565–570. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196674/pdf/nihms633602.pdf> accessed 26 August 2020.
[x] Trakatelli M et al., Skin cancer risk in outdoor workers: a European multicenter case-control study. J Eur Acad Dermatol Venereol. 2016;30 Suppl 3:5-11 <https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.13603> accessed 26 August 2020.