A summary of the updated report on the incidence and epidemiological trends of keratinocyte cancers in the UK 2013–2018

Skin cancer is the commonest cancer in the UK. Skin cancer referrals via the two-week wait (urgent suspected cancer) pathway outnumber any other suspected malignancy.1, 2 The commonest skin cancers are keratinocyte cancers (KCs) which represents Basal Cell Carcinomas (BCC) and Cutaneous Squamous Cell Carcinomas (cSCC). Accurate KC incidence reporting is crucial for healthcare planning.

Funding sources: none.
Conflicts of interest: the authors declare they have no conflicts of interest.
Data availability: the data that support the findings of this study are available from the corresponding author upon reasonable request.
A summary of the updated report on the incidence and epidemiological trends of keratinocyte cancers in the UK 2013-2018 DOI: 10.1111/bjd.20764 DEAR EDITOR, Skin cancer is the most common cancer in the UK. Skin cancer referrals via the 2-week wait (urgent suspected cancer) pathway outnumber any other suspected malignancy. 1,2 The most common skin cancers are keratinocyte cancers (KCs), which represents basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCCs). Accurate KC incidence reporting is crucial for healthcare planning. 3 Registration of KC is challenging owing to high numbers, multiplicity of cancers per person and various treatment modalities (not all surgical). The incidence of KC routinely reported in the UK is underestimated owing to the current United Kingdom and Ireland Association of Cancer Registries' rule recommending that only the first BCC and cSCC per person be registered; however, metachronous tumours are uniquely common to KC. 4 Previously, we validated the first per patient per annum (PPPA) technique where one tumour per patient per calendar year is counted to provide a better estimate of true tumour count, identifying 50% more tumours and estimating within 10% of the true tumour incidence without additional workload. 5 We provide a summary of the updated report on epidemiological trends for KC in the UK from 2013 to 2018 with three additional years of data, improved Welsh data and lifetime incidence reporting (the full version is available online). 6 Data from the National Cancer Registration and Analysis Service (NCRAS) in England were combined with data from national cancer registries in Scotland, Northern Ireland and Wales from 2013 to 2018 to calculate counts and incidence rates. 7 Further analysis was performed with NCRAS data only, using robust and Poisson regression. Lifetime incidence of nonmelanoma skin cancer (NMSC) was calculated via the Cancer Research UK current probability lifetime risk calculator, using the first all-time NMSC tumour registered. 8,9 Lifetime incidence analysis is limited to NMSC by mortality data and therefore includes rare NMSCs (e.g. Merkel cell carcinoma).
One in five (19Á7%) people develop at least one BCC, cSCC or other NMSC in their lifetime in England, which equates to one in four (22Á3%) men and one in six (17Á5%) women. For those under the age of 50 years, we saw a reversal of the male : female ratio, with BCC significantly more common in women than in men (incidence rate ratio 1Á37, 95% CI 1Á34-1Á41), as opposed to the trend seen in older patient groups and the whole population.
Incidence rates of first all-time and first PPPA BCC appear to plateau, whereas cSCC continues to increase significantly; however, more years of data are required to assess the trend. Similar findings showing a plateau in KC incidence rates have been predicted by Garbe et al. based on data from registries in Germany and Scotland. 10 This could be due to natural variation or changes in clinical practice and patient choice; greater awareness of end of life planning and prolonged waiting lists may encourage conservative management of these tumours, where appropriate, or perhaps there is greater skin cancer awareness and prevention in these populations.
The reversal of the male : female ratio in younger age groups is a matter of concern and may be due to lifestyle factors such as increased sunbathing among young women. With one in five persons developing NMSC in their lifetime, optimization of skin cancer research, prevention and clinical management is essential. Data availability: data used in this study are openly available in a public repository that issues datasets with digital object identifiers.

Supporting Information
Additional Supporting Information may be found in the online version of this article at the publisher's website: File S1 Full list of affiliations and acknowledgments.
The effect of surgical-site infections on patient-reported cosmetic outcomes of scars in dermatological surgery DOI: 10.1111/bjd.20773 DEAR EDITOR, Surgical-site infections (SSIs) are highly unsought complications that add unnecessary costs to patients and healthcare systems. [1][2][3][4] SSIs are also believed to contribute to poor wound cosmesis, 5 but studies supporting this idea are scarce. We aimed to examine whether differences were found in patient-reported scar outcomes between patients who had an SSI after dermatological surgery and patients with normal wound healing. This comparison was made using SCAR-Q, a validated, patient-reported outcome instrument. Following ethical approval and registration at ClinicalTrials.gov (NCT04744961), a case-control telephone interview study was conducted at the Department of Dermatology, Sk ane University Hospital, Sweden, from March to April 2021. Randomly selected patients over 18 years old diagnosed with SSIs who had undergone skin cancer surgery between March 2017 and March 2020 were compared with a matched control group with no registered SSIs. SSIs were retrieved from an electronic database containing all cases assessed by a dermatologist as infected. All surgical excisions were repaired by either direct closure or skin grafting.