Skin Cancer in Australia
The problem of skin cancer in Australia began over 200 years ago when the first fair-skinned Europeans settled on the shores of Sydney Harbour in 1788. Australians are more than five times as likely to develop skin cancer than any other form of cancer, and two of every three will have developed some form of skin cancer by the time they reach 70 years of age, the risk being higher in men (2 in 3) than in women (3 in 5).
Australia has one of the highest rates of skin cancer in the world. This is due largely to our climate, the fact that many of us have fair skin that isn’t suited to such harsh conditions, our proximity to the equator (high UV levels) and our social attitudes and love for the outdoors.
In 2011 over 2000 Australians died from skin cancer (ABS Causes of Death, 2012).
The good news is that skin cancer can be prevented and we can all minimise our life time chances of developing skin cancer by being SunSmart and getting to know our skin.
Who is at risk?
Everyone in Australia is at risk of developing skin cancer due to high levels of UV radiation throughout the year.
You are at increased risk of developing skin cancer if you have:
- lots of moles or freckles
- fair skin that burns easily and does not tan
- light coloured eyes (blue or green), light coloured hair (blonde or red)
- suffered sunburns, particularly as a child
- a family history of skin cancer
- used solaria
- spent lots of time in the sun, even if sunscreen was used.
Types of skin cancer
There are three main types of skin cancer named after the type of cell they develop from: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
Basal cell carcinoma and squamous cell carcinoma are also known as non-melanoma skin cancer (NMSC).
Basal cell carcinoma (BCC):
- are the most common type, accounting for about two-thirds of skin cancers
- grow slowly over months or years
- usually appear as small, round or flattened spots that are red, pale or pearly in colour
- can be scaly like a patch of eczema
- may look like an ulcer or sore that doesn't heal
- incident rates increases with age, however BCC can occur in people as young as their 20s.
Squamous cell carcinoma (SCC):
- account for about one-third of skin cancers
- can grow quickly over several months
- are usually scaly red areas that may bleed, ulcers or non-healing sores that may be painful
- appear on skin most often exposed to the sun
- tend to occur from the age of 40 onwards, incident rates increase with age
- on the lips and ears have a high risk of spreading
- are not as dangerous as melanoma, but they can spread to other parts of the body if left untreated. If you are concerned about a spot that won't heal see your GP immediately.
- are the least common but most aggressive form of skin cancer
- grow and spread rapidly
- can start in normal looking skin, or in a freckle or mole
- can grow anywhere in the body - not just areas exposed to the sun
* if treated early,95% of melanomas can be cured.
* Note: not all skin cancers look like the photographs above, these are for illustrative purposes only.
Nodular melanoma is a highly dangerous form of melanoma, because it grows very quickly in depth than other melanomas and can be life threatening if not detected early.
- grows quickly, in some cases can become life threatening in 6-8 weeks
- usually appears as a new small lump on the skin which may be black, brown, pink or red in color.
Other spots to watch for
Dysplastic naevi are moles that have an irregular shape and have an uneven colour. People with many dysplastic naevi are more likely to develop melanoma. If you have these moles, you should regularly check for any changes and look for new spots on the skin. If you notice any changes, you should see your doctor immediately.
Solar keratoses (sunspots)
- usually occur in people aged over 40
- appear on the head, neck, arms and legs
- usually flattish, scaly patches
- may be pale or red, and may sting if scratched
- may develop into squamous cell cancers.
They are not a skin cancer but they can be a pre-curser for squamous cell carcinoma and a risk factor for basal cell carcinoma and melanoma. They appear on sun exposed skin usually in people aged 40 and over, and are a sign that the body has had a lot of exposure to ultraviolet radiation (UVR).
Non-melanoma skin cancer (NMSC)
NMSC is the most common cancer in Australia. Cases of NMSC are not routinely reported to state and territory cancer registries however obtained from population surveys.
It has recently been estimated (2012) that there are over 700,000 cases of non melanoma skin cancers each year in Australia, this figure is set to climb further before it declines.
NMSC is often self detected and are usually removed/treated in doctor’s surgeries.
In 2010 there were 445 NMSC deaths reported (304 males and 141 females) (ABS: Causes of death 2010, 2012). The estimated total treatment cost for non-melanoma skin cancer during 2010 was $500 million making skin cancer, in financial terms, the most costly cancer burden to the health system. This figure is expected to reach $700 million in 2015.
Despite the high incidence rate of NMSC, mortality rates are relatively low at 3.2 per 100,000 population for males and 1.0 per 100,000 for females (AIHW, Cancer in Australia, 2008)
In 2012 the Medical Journal of Australia reported the total number of NMSC treatments increased from approx 412,493 in 1997 to 767,347 in 2010, the authors estimated the number of NMSC treatments would increase to 938,991 in 2015. The cost estimate (which does not include the patient's out of pocket expenses) was half a billion dollars in 2010.
Melanoma in Australia
Recent reports indicate that 10,342 Australians were diagnosed with melanoma in 2007 (5,980 men and 4,362 women) making melanoma the fourth most common cancer diagnosed in Australia (behind prostate, bowel and breast cancer) (AIHW 2010). There were 1,452 melanoma recorded deaths in 2010 (993 men and 459 women) (ABS, 2012). Melanoma accounts for approx 11% of all cancers diagnosed in Australia (AIHW,2008) and is the third most common diagnosed cancer in men and women (AIHW. Cancer in Australia 2008)
Australian adolescents have by far the highest incident of malignant melanoma in the world, compared with adolescents in other countries. It is the most frequent type of cancer in both sexes, and accounts for one third of all cancers in female adolescents and one quarter in males (Stiller CA: 2007). A history of multiple severe, painful sunburns is associated with malignant melanoma (Jones LME, 2000)
Over 8% of melanoma cases are diagnosed in people aged under 35 years old, 28% in those aged 35-54, 41% in those aged 55-74 and 23% in those aged 75 or older (AIHW, 2008).
Melanoma in the ACT
Cancer in the ACT Incidence and Mortality 2011 reported melanoma of the skin as the third most common diagnosed cancer in both males and females in the ACT. According to recent cancer statistics (2004 to 2008), 1 in 15 males and 1 in 25 females in the ACT developed melanoma before the age of 85 years.
A significant difference in mortality rates between males and females was also recorded, with females being lower. This may be due to the tendency of men tending to seek medical attention in the later course of the disease more then women, therefore decreasing their chances of survival. Of the 71 recorded melanoma deaths in the ACT between 2004 and 2008, 53 (or 75%) were males. Of these male deaths, over 80% occured in men over the age of 45.
The cumul risk to 75 years of dying from melanoma was one in 161 males and one in 779 females in the ACT (with one in 96 males and one in 395 females in the ACT before the age of 85 years old). As for most cancers, incidence and mortality of melanoma increased with age. Diagnosis of melanoma before the age of 20 is uncommon, with five (5) cases recorded in the ACT between 2004-2008. Incidence rates (per 100,000) for melanoma in the ACT were higher amongst females up until the age of 45, however after 45, there is a swing and male incident rates become higher, especially with older age.
The incidence rates for males and females in the ACT appeared to decrease slightly from 2005 to 2008, but it is too early to determine statistical significance.
The ACT Chief Health Officer's Report 2012 makes reference to two surveys, both highlighting declines in sun protection behaviours.
To access past ACT Health reports click here.