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Skin cancer in Australia

Table 1 shows the latest national incidence count of melanoma, as provided by the Australian Institute of Health and Welfare (AIHW), and the number of paid Medicare services for non-melanoma skin cancers (NMSC: basal cell carcinoma, squamous cell carcinoma) based on Medicare records. The latest mortality statistics for melanoma and NMSC are provided as reported by the Australian Bureau of Statistics (ABS) for 2020.

According to ABS data, of the Australians living with cancer in 2017-18, nearly one in three (30.8%) had skin cancer, making this the most common type of cancer.[1] It is estimated that at the end of 2017, there were 207,943 people in Australia living with melanoma who had been diagnosed between 1982 and 2017. [2] Medicare records show there are over 1,100,000 paid Medicare services for non melanoma skin cancers each year[3] – more than 3,000 treatments each day.

At least 2 in 3 Australians will be diagnosed with skin cancer in their lifetime.[4] The risk is higher in men than in women (70% vs. 58% cumulative risk of NMSC before age 70[5]; 65 vs. 44 age-standardised incidence rate of melanoma[2]). The risk of mortality is also higher for men - 67% of Australians who die from skin cancer are men.[6]

Skin cancer causes more deaths than transport accidents every year in Australia.[6]

Table 1 Australian incidence and mortality for non-melanoma skin cancer (NMSC) and melanoma


MenWomenTotal
Incidence


NMSC (number of paid Medicare treatment services, not people*) 2021720,711427,5031,148,214
Melanoma 2018 [2]8,9416,40315,344
Totaln/an/an/a
Mortality 2020 [6]


NMSC492230722
Melanoma9394621,401
Total1,4316922,123

* Medicare data for numbers of services for NMSC in 2021 are available,[3] otherwise latest incidence data for NMSC is from 2002.[7]

NMSC mortality includes deaths from the common skin cancers (SCC & BCC) and deaths from the rarer variants like Merkel cell tumours, dermatofibroma protuberans, and others.

AIHW data shows a recent decline in melanoma mortality rates (Figure 1). There has also been a recent decline in the age-specific incidence rates for melanoma among those under the age of 40 years, [8] and a significant decline in excision rates of non-melanoma skin cancer among those aged under 45 years.[9] This follows earlier observations of stable incidence trends among young people in Australia, who are likely to have reduced their UV radiation exposure as a consequence of long-running public education campaigns to improve sun protection. A similar pattern has been observed for several other high-risk countries including New Zealand, North America, Israel and Norway.[10] These recent changes illustrate the importance of decreased UV exposure in childhood as a key contributor in lowering skin cancer risk later in life.[10]

Figure 1 Mortality rates in Australia 1982 to 2020.[2]



Melanoma incidence and mortality

Melanoma of the skin is the third most commonly diagnosed cancer in in Australia (excluding NMSC).[2] In 2018,15,344 new cases of melanoma were diagnosed in Australia[2], and in 2020, 1,401 people died.[6]

Table 2 Australian incidence and mortality of melanoma


MenWomenTotal
Incidence 2018[2]


Count8,9416,40315,344
Age-standardised rate65.544.354.1
Mortality 2020 [6]


Count9394621,401
Age-standardised rate6.42.74.4

The rates were age-standardised to the Australian population as at 30 June 2001, and are expressed per 100,000 population

In Australia, the age-standardised incidence rate for melanoma increased by 103% between 1982 and 2018, from 26.7 cases per 100,000 persons to 54.1 cases per 100,000 persons,[2]. However, how much of this increase is due to a real increase in the underlying disease, and how much is due to improved detection methods, is unknown. The incidence of melanoma of the skin rose at around 5.0% per year during the 1980s, moderating to 2.8% per year after that up until 2010.[12] It is predicted that the initial rapid increase is partly attributable to individual behaviour and the use of solariums, resulting in increased exposure to solar ultraviolet radiation.[13][14] The moderated trend seen after the 1980s is consistent with increased awareness of skin cancer and improved sun protective behaviours as a result of extensive skin cancer prevention programs dating back to the 1980s.[8]

Gender

In 2022, Australian women were estimated to have a 1 in 21 chance of being diagnosed with melanoma before the age of 85, whereas men were estimated to have a 1 in 14 risk.[2]

As noted above, the age-standardised incidence rate of melanoma increased by 103% between 1982 and 2018, from 26.7 per 100,000 persons to 54.1 per 100,000 persons.[2] This increase was more marked for men than women. For men the age-standardised rate increased by 135% from 27.9 to 65.5 cases per 100,000 men, while for women the increase is 68%, from 26.3 to 44.3 cases per 100,000 women.[2]

Gender differences are also observable in relation to mortality. Overall, in 2020 Australians had a 1 in 228 chance of dying from melanoma by age 85 – men had a 1 in 166 chance and women had a 1 in 368 chance.[2]

Mortality rates for melanoma among men increased from 6.4 deaths per 100,000 in 1982 to a peak of 9.6 deaths per 100,000 in 2011[2], before declining to the lowest recorded rate of 6.4 deaths per 100,000 in 2020.[6] For women, rates increased from 3.2 deaths per 100,000 in 1982 to a peak of 3.9 deaths per 100,000 in 2006 [2], before declining to the lowest recorded rate of 2.7 per 100,000 in 2018. [6] The estimated age-standardised mortality rate for men and women in 2022 was 5.2 and 2.4 per 100,000 respectively. [2]

Age

There is an observable age gradient for melanoma incidence according to AIHW data:

  • 8.0% of people diagnosed with melanoma are aged under 40 years;
  • 10.7% are aged 40-49;
  • 17.1% are aged 50-59;
  • 23.9% are aged 60-69;
  • 24.0% are aged 70-79; and
  • 16.3% are aged 80 or older.[2]

In 2018, the mean age for melanoma diagnosis was 66 years among men and 62.3 years among women.[2]

Melanoma is the most common cancer diagnosed in young Australians aged 15-29 years, accounting for 15% of all cancers in this age group.[2] However, research in Queensland suggests a decline in the incidence of thin invasive melanoma since the mid- to late 1990s among young people who have been exposed to Queensland’s primary prevention and early detection programs since birth.[15] Nationally, age-standardised incidence rates for melanoma fell from 96 new cases per 1 million young Australians (aged 15-24) in 1985–1989 to 44 new cases per 1 million in 2010–2014.[16]

In 1982, the risk of being diagnosed with melanoma by the age of 30 was around 1 in 600 people. Incidence risk trended upwards and in 1997 had risen to around 1 in 430 people. From 1997, the risk of melanoma by the age of 30 began to fall. Based on current projections, in 2020 the risk of being diagnosed with melanoma by the age of 30 (estimated at around 1 in 1,170 people) has fallen to less than half of the risk in 1997. Following years of consistent decline, the risk of death from melanoma by the age of 30 in 2020 is estimated to be less than one-sixth of the risk in 1982 (1 in 62,000 persons in 2020 compared with 1 in 9,100 persons in 1982). [2]

Location

Australia’s high incidence of skin cancer is attributable to a combination of its predominantly fair-skinned population and high levels of ambient UV radiation due to proximity to the equator.[17][18][19]

The International Agency for Research on Cancer (IARC) estimates that in 2020, Australia had the highest age-standardised melanoma incidence rate (36.6 per 100,000, standardised to World Population) and the equal sixth highest mortality rate (2.4 per 100,000) of melanoma in the world. [20] Melanoma incidence rates in Australia and New Zealand are around two to three times higher than those in Canada, the United States and the United Kingdom. Although mortality rates are quite low, in Australia and New Zealand they are still around 1.5 - 2.5 times those in Canada, the United States, and the United Kingdom.[20]

Within Australia in 2018, people in Queensland faced the highest risk of developing melanoma, followed by Tasmania, New South Wales, Western Australia, Australian Capital Territory, Northern Territory, Victoria and South Australia.[2]

During the period 2012-2016, those living in Inner regional areas had the highest age-standardised incidence rates for melanoma, with 62 cases per 100,000 people. The next highest rate was in Outer regional areas (57.3), followed by Remote (50.3), Major Cities (47.9) and Very Remote (33.9 cases per 100,000 people). During 2015 - 2019 mortality rates were highest in Inner Regional areas (5.8 deaths per 100,000) followed by Outer Regional (5.5), Remote (5.1) and Very Remote (34.9). Major Cities had the lowest mortality rate, with 4.4 deaths per 100,000 people. [21]

Socio-economic status

In 2012-2016 the melanoma incidence rate was highest among the highest socioeconomic group, and lowest among the lowest socioeconomic group. In 2015-2019 the mortality rate was highest in the lowest socioeconomic group, and lowest in the top two highest socioeconomic groups. [21]

Indigenous status

In 2012-2016, the average number of annual melanoma cases was 30 for male Indigenous Australians, and 22 for female Indigenous Australians. In 2015-2019, the average number of deaths per year for male Indigenous Australians and female Indigenous Australians were 4 and 2, respectively. [22]

In 2012–2016, the incidence of melanoma was 16.2 cases per 100,000 among Indigenous Australians, compared with 39.7 cases per 100,000 among non-Indigenous Australians.[22] Mortality rates were also lower for Indigenous Australians (2.2 deaths per 100,000) compared with non-Indigenous Australians (5.1 deaths per 100,000).[21]



Non-melanoma incidence and mortality

Although NMSC is the most common cancer type in Australia, it is often reported that breast cancer is the most common cancer in women and prostate cancer is the most common in men. That’s because most Australian cancer registries don’t routinely collect data for these more common forms of skin cancer – only the most serious, melanoma.[23] NMSC are often self-detected and are usually removed in doctors’ surgeries, sometimes without histological confirmation due to destructive treatment techniques, or treatment with topical creams[5] where tumour sites are only excised in post-treatment testing.

As the latest incidence data is estimated from self-reported, histologically confirmed (81.5%) and unconfirmed NMSC treated in 2002,[5][7] Medicare service numbers are provided as a proxy measure below.

Table 3: Australian incidence and mortality of Non-Melanoma Skin Cancers



MenWomenTotal
Incidence2021[3] (number of paid Medicare treatment services, not people*)720,711427,5031,148,214
Incidence per 100,0002002[5] (estimated from survey)1,5311,0361,271
Mortality2020[6]492230722

* Medicare data for numbers of treatment services for NMSC in 2021 are available,[3] otherwise latest incidence data for NMSC is from 2002.[7]

NMSC mortality includes deaths from the common skin cancers (SCC & BCC) and deaths from the rarer NMSCs like Merkel cell tumours, dermatofibroma protuberans etc.

NMSC accounted for 1,148,214 paid Medicare services in 2021 as evaluated from data on NMSC excisions, curettage, laser, or liquid nitrogen cryotherapy treatments.[3]

Findings from the annual BEACH surveys of general practice conducted from 2006 to 2016 showed that skin cancer predominated as the cancer most often managed (by way of medications, clinical and procedural treatments, ordering of pathology or imaging tests) in GP-patient encounters, and was consistently among the top ten conditions managed by GPs.[24]

Despite the high incidence rate of NMSC, the age-standardised mortality rates are relatively low at 3.3 deaths per 100,000 population for males and 1.2 deaths per 100,000 for females.[6]



Economic impact

Skin cancer cost the Australian Health System more than $1.68 billion (including diagnosis, treatment and pathology) in 2018/19. $1.327 billion of this was attributed to NMSC and $357 million was attributed to melanoma.[25]

It is the most expensive cancer type to treat, and overexposure to solar UVR is also estimated to account for the highest amount of spend on cancer that can be attributed to a risk factor, at 31%.[22]



Survival

In Australia, relative survival after diagnosis of melanoma of the skin is very high when compared with other types of cancer.[2] The 5-year relative melanoma survival rate increased from 89% in the period 1989-1993 to 93% in 2014-2018[2]

In the period 2014-2018[2]:

  • Five-year relative survival for melanoma was greater for women compared with men (94.9% compared with 91.7%).
  • Five-year relative survival for rare types of NMSC was greater for women compared with men (73.1% compared with 68.2%)
  • Melanoma survival was high for all age groups, gradually declining with age (96% or higher 5-year relative survival for those below 40 years as compared with 80% for those aged 80-85 years).

In 2011, although survival was high overall it varied considerably by stage at diagnosis. Five-year relative survival was almost 100% for melanoma diagnosed at Stage 1, but only 26% when diagnosed at Stage IV.[2]

Australian survival rates from melanoma are generally higher than in other countries due to the high proportion of thin lesions, according to the Cancer Epidemiology Centre at Cancer Council Victoria. Survival rates are higher in countries where there is greater melanoma awareness due to earlier detection.[26]

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Last modified: 27 July 2022


References

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