Abstract
The epidemiology of non-melanoma skin cancer (NMSC) is not well understood due to exclusion from most US cancer registries. Patients with at least two claims with a NMSC diagnosis (ICD-9-CM 173.xx) at least 60 days apart, or at least one claim for a NMSC-specific treatment from 1/2010 to 12/2010, were identified from a large US commercial insurance claims database and grouped into one of three cohorts: metastatic (MET), locally advanced (LA), or “all other”. MET patients had at least two claims with a metastasis code at least 30 days apart. LA patients had at least two visits to a medical oncologist, one diagnostic imaging service, two radiation therapy services, or one visit to two or more physician specialties. Remaining patients were “all other”. Incidence and prevalence of NMSC were calculated from among the total number of persons continuously enrolled in the plan during the study period and standardized to the 2010 US population. From among 6,610,256 patients, there were 47,451 incident cases of NMSC (MET n = 16, LA n = 387, all other n = 47,048). The age-adjusted incidence rate of 693 per 100,000 persons (2010 population) approximates to 2,139,535 total NMSC cases in the US (0.7 % of population). 671 prevalent cases had advanced disease (MET n = 43, LA n = 628); an age-adjusted rate of 0.6 and 10 per 100,000 US persons equivalent to 1,993 and 29,841 MET and LA cases, respectively. Although NMSCs rarely progress, the number of patients with advanced disease is significant. Further studies to determine proportions of advanced NMSC by subtype are needed.
Highlights
Non-melanoma skin cancer (NMSC) is the most common cancer in the United States and is steadily increasing in annual incidence
Medical claims include diagnosis codes recorded with International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM), procedures recorded with ICD-9 procedure codes, current procedural terminology (CPT) codes, or healthcare common procedure coding system, and revenue codes
The study data were de-identified and data were accessed in accordance with the Health Insurance Portability and Accountability Act [7] and, institutional review board approval was not required for this study
Summary
Non-melanoma skin cancer (NMSC) is the most common cancer in the United States and is steadily increasing in annual incidence. A limited number of publications exist on the incidence and prevalence of NMSC due to exclusion from US cancer registries. Rogers et al [13] estimated that 2,152,500 persons in the United States were treated for 3,507,693 NMSCs in 2006. In the Medicare population, the number of annual incident NMSC cases increased an average of 4.2 % from 1992 to 2006 [13]. The high volume of cases places NMSC among the most costly of cancer malignancies. In an analysis of Medicare billing claims in 1992–1995, NMSC accounted for 4.5 % of the $13 billion spent on cancer management [8]
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