Aging trends in skin cancer: A long-term observational study in Japan

Abstract

To the Editor: Incidence of skin cancer is increasing worldwide, particularly affecting the older population.1Urban K. Mehrmal S. Uppal P. et al.The global burden of skin cancer: a longitudinal analysis from the Global Burden of Disease study, 1990–2017.JAAD Int. 2021; 2: 98-108Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar This can be mainly attributed to increased cumulative ultraviolet exposure rather than other risk factors including exposure to ionizing radiation, immunosuppression, and long-term scar inflammation.1Urban K. Mehrmal S. Uppal P. et al.The global burden of skin cancer: a longitudinal analysis from the Global Burden of Disease study, 1990–2017.JAAD Int. 2021; 2: 98-108Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 2Lubeek S.F.K. van Vugt L.J. Aben K.K.H. et al.The epidemiology and clinicopathological features of basal cell carcinoma in patients 80 years and older: a systematic review.JAMA Dermatol. 2017; 153: 71-78Crossref PubMed Scopus (36) Google Scholar, 3Garcovich S. Colloca G. Sollena P. et al.Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology.Aging Dis. 2017; 8: 643-661Crossref PubMed Scopus (135) Google Scholar The rapidly growing elderly population in Japan has led to an alarming increase in the number of skin cancer patients.4Umezono Y. Sato Y. Noto M. et al.Incidence rate of cutaneous squamous cell carcinoma is rapidly increasing in Akita Prefecture: urgent alert for super-aged society.J Dermatol. 2019; 46: 259-262Crossref PubMed Scopus (12) Google Scholar However, studies comparing aging trends between patients with primary skin cancer and other organ cancers have not been reported. Herein, we conducted a long-term observational study focusing on the aging trends in skin cancer, at a tertiary cancer care hospital in Japan. We retrospectively collected data of 5,669 patients who received treatment for primary skin cancer from 1989 to 2021 at the Niigata Cancer Center Hospital. The median age of skin cancer patients was observed to be 77 years (6-107), and included patients suffering from melanoma (n = 610), basal cell carcinoma (n = 1579), squamous cell carcinoma (n = 1161), Bowen's disease (n = 739), actinic keratosis (n = 994), extramammary Paget's disease (n = 210), skin appendage carcinoma (n = 215), and others (n = 161). Fig 1 shows the age-wise distribution of the 5,669 skin cancer patients. The percentage of patients older than 70 years increased from 44% in 1989 to 74% in 2021. Of note, in the year 2021, 17% patients were older than 90 years of age. Fig 2 shows the change in median age of patients with melanoma (n = 561) and nonmelanoma skin cancer (NMSC, n = 4729) from 1991 to 2020, compared with primary other organ cancers such as the esophagus (n = 3280), stomach (n = 11,066), colon (n = 7525), liver (n = 1000), pancreas (n = 1820), lungs (n = 11,561), breast (n = 8785), uterus (n = 2778), ovary (n = 1099), prostate (n = 5363), urinary tract (n = 5349), and thyroid (n = 1842). In the past 5-year period, the median age of NMSC patients (80 years) was the highest of all, followed by that of liver cancer patients (73 years). The increasing rate of 16% for breast cancer was the highest, followed by liver cancer (14%) and NMSC (12%). The median age of melanoma patients did not show significant variations.Fig 2Changes in median ages of patients with major organ cancers. The graph shows changes in the median ages of major organ cancer patients divided into 5-year intervals from 1991 to 2020. Non-melanoma skin cancers (NMSC) showed more prominent aging trend than the other types of cancers.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The results of our study revealed the prominent aging trends in nonmelanoma skin cancer (NMSC) patients, compared to the other types of cancers. Our data is valuable for understanding long-term trends in NMSC, despite the study limitation from a single institution. The absence of aging trends in melanoma patients can probably be attributed to the high proportion of acral melanoma among Japanese patients. Cancer treatment for elderly patients is complicated due to factors such as age-related decline in physical function, cognitive impairment, and the need for social care. Skin cancer in elderly patients is likely to be diagnosed at a more advanced stage, making the management more difficult.5Lues A.J.G. Haisma M.S. Terra J.B. et al.Age-related differences in tumour characteristics and prognostic factors for disease progression in cutaneous squamous cell carcinoma of the head and neck.Acta Derm Venereol. 2022; 102adv00652Google Scholar We need to consider educational strategies for early diagnosis and treatment targeting elderly patients. None disclosed.

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