Non-Melanoma Skin Cancers Killing More Senior
Citizens in Australia
More elderly dying from Squamous Cell and Merkel
Cell Carcinomas
April 14, 2008 – Skin cancer is the most common
cancer in the U.S. – more than a million are diagnosed annually – but it
is the melanoma skin cancer that older Americans fear most, because of
the high death rate. There is a new skin cancer worry for senior
citizens emerging in Australia, however, where deaths from non-melanoma
skin cancer (NMSC) are increasing rapidly among older Australians.
Of the 59,940 melanomas that will be diagnosed in
the U.S. this year, more than 8,000 will result in death. But, the
Australian study indicates there is more for the elderly to worry about.
This new Western Australian study has revealed the
mortality from NMSC, commonly considered less dangerous than melanoma,
is affecting older Australians at a worrying rate.
Researchers at the Western Australian Institute for
Medical Research (WAIMR) found West Australians above the age of 69,
especially men, accounted for 70 percent of deaths from non-melanoma
skin cancer in Western Australia, and most primary cancers occurred in
areas of high sun exposure.
Most deaths noted in the Australian study were
associated with squamous cell carcinoma and Merkel cell carcinoma. The
research found no deaths recorded from basal cell carcinoma (BCC), one
of the most common NMSCs, or solar keratosis. (Read more about squamous
cell and Merkel cell carcinoma below this news report.)
The study has prompted health experts to urge older
people to stay vigilant about sun protection and get regular skin
checks. (Note: many senior citizens are also vulnerable to skin cancer
because of a weakened immune system. Read more below news report.)
U.S. Skin Cancer Facts
● Skin cancer is the most common form of cancer in the United
States. More than 1 million skin cancers are diagnosed annually.
● Approximately 59,940 melanomas will be diagnosed this year,
with nearly 8,110 resulting in death. Men: 33,910 cases and
5,220 deaths. Women: 26,030 cases and 2,890 deaths.
● More than 20 people die each day from skin cancer,
primarily melanoma.
● While melanoma is uncommon in African-Americans, Latinos,
and Asians, it is most deadly for these populations because it
is more likely to develop undetected.
● Survival rate for patients with early detection is about
99%. The survival rate falls to between 15 and 65% or higher,
depending on how far the disease has spread.
● The cost of melanoma in the U.S. is more than $740 million
annually.
● 1 in 59 men and women will be diagnosed with melanoma
during their lifetime.
● Skin cancer is the #1 cancer in men over age 50, ahead of
prostate, lung and colon cancer.
● The majority of people diagnosed with melanoma are white
men over age 50.
● Squamous cell carcinoma is the second most common form of
skin cancer. More than 250,000 cases are diagnosed each year,
resulting in approximately 2,500 deaths each year.
● One in 5 Americans and one in 3 Caucasians will develop
skin cancer in the course of a lifetime.
● More than 90 percent of all skin cancers are caused by sun
exposure.
● A person's risk for skin cancer doubles if he or she has
had five or more sunburns.
● Men over age 40 spend the most time outdoors and have the
highest annual exposure to ultraviolet radiation.
● Melanoma is the third most common cancer in women aged
20-39.
● The percentage of women under age 40 with basal cell
carcinoma has tripled in the last thirty years, while their rate
of squamous cell cancer has increased four-fold.
The Australian Cancer Council WA Director of
Education and Research and co-author of the paper, Terry Slevin, said
the study’s results should act as a strong reminder for older West
Australians to check their skin and see their doctor at the first sign
of anything suspicious.
“Older people may have become blasé about NMSC
because for the most part they can just be cut out, but as this research
shows, NMSC is serious and can be deadly if left untreated,” he said.
“It’s important people understand that NMSCs are
preventable from middle age – it’s wrong to think all the damage to our
skin is done in childhood and nothing can be done after that to avoid
skin cancer.”
The research published in the most recent edition
of Cancer Causes Control, found 70 percent of deaths from NMSC occurred
among people aged 70 years and over. More than 70 per cent of those were
men, and in most cases the primary cancer developed on the face, ears,
hands or scalp.
“These results should be a stark reminder for older
people, especially blokes, that they should be more vigilant in having
their skin checked and do something if they notice any changes in their
skin,” Mr. Slevin said.
“The message these findings send us is that it’s
never too late to prevent skin cancer and regular skin checks are
important to catch skin cancers early, before they become a problem.”
Each year in Western Australia, it's estimated that
around 30,000 non-melanoma skin cancers are removed and there are 37
deaths from these types of cancers.
Author of the paper, WAIMR Associate Professor Lin
Fritschi, said the research was the first definitive evidence that
deaths from NMSC in Australia was primarily caused by cancer resulting
from excessive sun exposure.
“The average age of death caused by NMSC was about
77 years old, and most primary cancers appeared in areas of high sun
exposure – for men, the scalp was the primary cancer site in a quarter
of these deadly cancer cases,” she said.
“These cancers can mostly be prevented by applying
the ‘slip, slop, slap’ rule and early detection.
“There could be a number of reasons why older
people are not picking up these cancers early enough such as poor
eyesight and less mobility to check their own skin, illness or dementia.
“In light of these findings, skin cancer
examinations really need to become a high priority for older people as
well as their GPs, nurses and care givers.”
Weakened Immune System can Lead to
Skin Cancer
HIV, several diseases, and certain medicines used
in treating organ transplants and other conditions all have something in
common: They can weaken the immune system, leading to skin cancers.
The Trouble with Transplants
Organ transplant patients are particularly at risk. “Transplant patients
have 64 times as many
squamous cell carcinomas (SCCs, common skin cancers) as the general
population. Heart transplant patients are at even greater risk,” says
Clark C. Otley, MD, Professor and Chair of Dermatologic Surgery, Mayo
Clinic, College of Medicine, Rochester, MN.
To prevent organ rejection, transplant patients
receive medications to suppress the immune system, the body’s biological
defense against infection, viruses, and disease. They are left even more
vulnerable to skin cancer than patients who have HIV/AIDs or receive
cancer chemotherapy.
While most skin cancers in the immunosuppressed are
SCCs,
basal cell carcinoma (BCC) presents a tenfold risk and
melanoma a threefold risk, compared to the general population. Some
rare skin cancers, such as Merkel cell carcinoma, also show up
sometimes.
“I have patients who develop more than 100 SCCs in
a year,” states Dr. Otley. “Some have had 1,000 over a lifetime.”
Squamous cell carcinoma (SCC) is the second most
common form of skin cancer, with over 250,000 new cases per year
estimated in the United States. It arises in the squamous cells that
compose most of the upper layer of the skin.
Most SCCs are not serious. When identified early
and treated promptly, the future is bright. However, if overlooked,
they are harder to treat and can cause disfigurement. While 96 to 97
percent of SCCs are localized, the small percentage of remaining cases
can spread to distant
organs and become life-threatening.
Cause
Most cases of squamous cell carcinoma are caused by
chronic overexposure to the sun. Tumors appear most frequently on
the sun-exposed face, neck, bald scalp, hands, shoulders, arms and
back. The rim of the ear and the lower lip are especially vulnerable to
these cancers.
Merkel cell carcinoma (MCC) is a rare, aggressive
type of skin cancer that forms on or just under the skin. It is also
called primary small cell carcinoma of the skin, trabecular carcinoma,
APUDoma, neuroendocrine carcinoma, endocrine carcinoma, or primary
undifferentiated tumor of the skin. MCC is believed to start in
neuroendocrine cells called Merkel cells. These cells release hormones
into the blood when stimulated by the nervous system. They migrate from
part of the nervous system called the neural crest to the skin. Merkel
cells are believed to play a role in making the skin sensitive to touch.
The exact cause of MCC is unknown, but it appears
to be linked to sun exposure and immunosuppression (suppression of the
body’s immune system and its ability to fight infections or disease).
April 14, 2008 – Skin cancer is the most common
cancer in the U.S. – more than a million are diagnosed annually – but it
is the melanoma skin cancer that older Americans fear most, because of
the high death rate. There is a new skin cancer worry for senior
citizens emerging in Australia, however, where deaths from non-melanoma
skin cancer (NMSC) are increasing rapidly among older Australians.