Trends in incidence and survival analysis in non-melanoma skin cancer from 1994 to 2012 in Girona, Spain: A population-based study J. Rubió-Casadevall a,b,c, *, A.M. Hernandez-Pujol d , M.C. Ferreira-Santos b,d , G. Morey-Esteve d , L. Vilardell b,d , G. Osca-Gelis b,d,e , N. Vilar-Coromina b,c,f , R. Marcos-Gragera b,d a Medical Oncology Department, Catalan Institute of Oncology, Girona, Spain b Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain c Faculty of Medicine, University of Girona (UdG), Spain d Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health, Government of Catalonia, Catalan Institute of Oncology, Girona, Spain e Research Group on Statistics, Econometrics and Health (GRECS), University of Girona (UdG), Spain f Dermatology Unit, University Hospital Josep Trueta, Catalan Institute of Health, Girona, Spain A R T I C L E I N F O Article history: Received 2 May 2016 Received in revised form 1 September 2016 Accepted 6 September 2016 Available online xxx Keywords: Non melanoma skin cancer Cutaneous squamous cell carcinoma Basal cell carcinoma Merkel Cell Carcinoma Dermatofibrosarcoma Protuberans Adnexal and Skin Appendage Neoplasm Incidence Survival Population-based Cancer Registry Epidemiology A B S T R A C T Introduction: We present an epidemiological study focused on Non-melanoma skin cancers (NMSC), including squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Merkel cell carcinoma (MCC), dermatofibrosarcoma protuberans (DFS) and adnexal and skin appendages neoplasm (ASAN), a neoplasm understudied in cancer registries. Material and methods: We analyze trends of incidence and survival of NMSC registered with the Cancer Registry of Girona, Spain. Results: We found 14389 cases of NMSC, accounting 3,474 SCC, 10729 BCC, 33 MCC, 61 DFSP and 71 ASAN. Incidence increased significantly in SCC and BCC with annual percentage of change of 1.6 and 1.5, respectively, but not in MCC, DFS or ASAN. Five-year relative survival for both sexes was 90.1% in SCC, 99.8% in BCC, 44.2% in MCC, 93.7% in DFS and 84% in ASAN. Conclusions: Our study confirms the increasing incidence and good survival of SCC and BCC and enhances knowledge on the epidemiology of the less incidental NMSC. ã 2016 Elsevier Ltd. All rights reserved. 1. Introduction Non-melanoma skin cancers (NMSCs) are tumors that have been widely disregarded in population-based cancer registries (CRs). This is probably due to their low lethality and the fact that they are usually managed in outpatient settings. In the past, histological confirmation was not always performed. Many CRs do not record these tumors, or their recording lacks completeness. In the latest edition of Cancer Incidence in Five Continents [1], the number of annual cases between different CRs in Spain ranged from 1 to 2995, reflecting the fact that some CRs did not registered squamous- and basal-cell carcinomas of the skin. Despite this, some publications have appeared in the past decade concerning the increasing incidence of squamous- and basal-cell carcinomas of the skin; this could potentially be the result of increased exposure to sunlight, changes in clothing style, or increased longevity. Few publications have focused on the epidemiology of Merkel-cell carcinoma (MCC) or other rare malignant tumors of the skin, or on patient survival. Since its founding in 1994, the Girona Cancer Registry (GCR) has collected data on non-melanoma skin cancer, including squamous- cell carcinoma (SCC) and basal-cell carcinoma (BCC) of skin, MCC, dermatofibrosarcoma protuberans (DFSP), and adnexal and skin appendages neoplasm (ASAN). * Corresponding author at: Medical Oncology Department, Catalan Institute of Oncology, Girona, Spain. E-mail address: jrubio@iconcologia.net (J. Rubió-Casadevall). http://dx.doi.org/10.1016/j.canep.2016.09.001 1877-7821/ã 2016 Elsevier Ltd. All rights reserved. Cancer Epidemiology 45 (2016) 6–10 Contents lists available at ScienceDirect Cancer Epidemiology The International Journal of Cancer Epidemiology, Detection, and Prevention journal homepage: www.cancerepidemiology .net