Non-melanoma skin cancers (NMSCs), characterized by malignant growth of the epithelial layer or external surface of the skin, are the most prevalent form of skin cancer in the United States.1 Since the 1960s, the incidence of NMSC has increased 4% to 8% each year, with an estimated 1.4 million cases occurring in 2000 alone.1–6 NMSC is more common than lung, breast, prostate, and colon cancers combined.6,7 Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) constitute 75% and 20% of all NMSCs, respectively. Although NMSC accounts for a low mortality, with approximately 2000 to 2500 deaths per year in the United States, it is associated with considerable patient morbidity.2,8–13
NMSC is generally a malignancy encountered in the elderly population, with Medicare the primary payer for most NMSC treatment. The estimated annual cost of NMSC care is $426 million for the Medicare population and $650 million for the entire United States population.14,15 NMSC Medicare costs, which are approximately 6 to 7 times greater than those for treating melanoma, rank fifth behind prostate, lung, colon, and breast carcinomas.16
The cost of NMSC care primarily depends on 2 factors: care settings and treatment modalities. NMSC treatment is provided in hospitals, ambulatory/outpatient surgical centers, and physician offices. NMSC is most commonly treated in the United States by dermatologists, although plastic surgeons, otolaryngologists, facial plastic surgeons, general surgeons, and family physicians also administer treatment.6,17,18 Treatment modalities for NMSC include excision and closure, electrodessication and curettage (EDC), cryosurgery, radiotherapy, topical treatment with imiquimod, and Mohs micrographic surgery (MMS).
A major goal of NMSC treatment is to remove the tumor while preserving maximal function and cosmesis. Cost is also an important consideration. The cost of NMSC treatment is affected by the size and location of the tumor. NMSC most commonly affects chronically sun-exposed sites, including the trunk and upper extremities, and particularly the head and neck.19 The 5-year recurrence rate for traditional surgical excision is 10.1% for primary BCC20 and from 10.9% to 18.7% for SCC.21 The 5-year cure rates of 99% reported for primary BCC and 95% to 97% for SCC (lip) treated with MMS are unparalleled by any other modality.20,22
The substantial treatment costs have led to a re-evaluation of how NMSC care should be delivered. The rise in NMSC incidence remains a personal burden to patients and a financial burden to the health care system.
This article summarizes the available research on the cost implications of NMSC, with a focus on comparing the costs of NMSC within different care settings and different physician groups involved, and evaluating results of recent studies comparing the cost of different treatment modalities with respect to procedure type, tumor size, and tumor location. Analysis and review of the current literature on costs for NMSC treatments and care settings will help direct policies and guidelines for the treatment of NMSC.
Tejaswi Mudigonda and Drs. Pearce and Yentzer have disclosed that they have no financial interests, arrangements, or affiliations with the manufacturers of any products discussed in the article or their competitors. Dr. Williford had disclosed that he is a consultant for or on the advisory board of Graceway Pharmaceuticals, LLC. Dr. Feldman has disclosed that he has financial relationships with Galderma; GlaxoSmithKline/Stiefel Laboratories Inc.; Astellas; Abbott Laboratories; Warner Chilcott; Centocor, Inc.; Amgen Inc.; Photomedex; Coria/Healthpoint/Valeant; Pharmaderm/Nycomed; Dermatology Foundation; American Society for Dermatologic Surgery; American Acne Rosacea Society; National Psoriasis Foundation; Ortho Pharmaceuticals; Aventis Pharmaceuticals; Roche Dermatology; 3M; Bristol-Myers Squibb Dermatology; Novartis Pharmaceuticals Corporation; Merck & Co., Inc.; Xlibris; Suncare Research; Peplin; Medscape; Kikaku; Caremark; Informa; and Medical Quality Enhancement Corporation.
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