Although cutaneous malignant melanoma (MM) is less common than the basal cell and squamous cell carcinomas, it has a much higher mortality. It remains a major concern for healthcare services as its incidence continues to increase globally, especially amongst fair-skinned people, by 3 to 7% annually. In the USA, 22 out of 100,000 men and 14 out of 100,000 women are affected. The increasing incidence of melanoma in the USA has also been associated with an increased mortality with total deaths of 7770 in 2005. A similar picture is seen in Europe where in the year 2000, 8300 males died out of the approximately 26,100 diagnosed with MM. Out of approximately 33,300 diagnosed female cases, 7600 died. Since MM affects relatively younger individuals, this cancer is also important in terms of years of potential life of the person lost per year. International literature indicates that, in Belgium, an individual dying of MM would die approximately 6-8 years before the age of 65 years and in Denmark 14-15 years[128,129] while in the USA almost 17 years. In those patients who are diagnosed with advanced MM, the median survival is approximately 6 months with a 5-year survival of approximately 5%.[131,132]
Patients with recent diagnosis of MM exhibit the same levels of psychological distress as reported by other cancer patients. At 3 months after surgical intervention, around a fifth of MM patients reported clinically high levels of anxiety, whilst depressive symptoms seem more evident amongst patients with metastatic melanoma. Women with the disease have higher levels of anxiety, depression, tiredness and sleep disturbance compared with men.
Squamous cell and basal cell carcinomas (also known as nonmelanoma skin cancers [NMSCs]) of the skin together are the most frequent malignant tumors in the Caucasian population. Their incidence is 18-20-times greater than MM and is increasing. The average increase in white populations in the USA, Australia, Canada and Europe was estimated to be 3-8% per year.[138,139] The incidence of newly diagnosed basal cell carcinomas and squamous cell carcinomas among the Chinese population in Hong Kong in 1990 and 1999 was 16 and 31.8 and 6.9 and 11.6 per 10,000, respectively, for new skin attendances.
The anatomical location of NMSCs on cosmetically sensitive areas such as the face, head and neck, may give rise to psychological and social consequences. The situation is compounded by the fact that most of the available treatments mean that patients are left with scars mostly on visible areas and sometimes with significant disfigurement. NMSCs are also associated with a significant economic burden. In a study of 28.3 million beneficiaries of a private medical insurance company, 2.8% had and were treated for NMSCs in 1995. The estimated total costs of all treatments for NMSC were approximately $285 million/year with average physician charges of $329 per patient.
Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(3):271-283. © 2009 Expert Reviews Ltd.
Cite this: Burden of Skin Diseases - Medscape - Jun 01, 2009.