Service planning in Europe would benefit from complete registration of NMSCs

Basal cell carcinoma (BCC) is a type of non-melanoma skin cancer (NMSC) and is the most frequently occurring type of cancer. However, unlike other cancer types, not all instances of BCC are registered with cancer registries, leading to the under-reporting of cases. BCC is rarely fatal and largely treatable when caught early. However, surgery is required in most cases to remove the tumour. Under-reporting of cases leads to underestimations of the financial burden of BCC and less accurate data for service planning.

Within Europe, there is a variety of policies regarding the registration of BCC cases. Within the UK and Spain, it is recommended to report only the first instances of histologically confirmed BCC per person. However, regional policies vary and data quality is inconsistent. This is largely due to resource limitations, treatment in out-patient clinics without histological confirmation and practicalities regarding the coding of multiple BCCs presenting in a single patient simultaneously. According to recommendations from the Association of Population-Based Cancer Registries in Germany (GEKID), cancer registries should report all cases of NMSC. However, health insurance providers are not legally obligated to reimburse these notifications, leading to under-reporting. A 2012 study by de Vries and colleagues in Archives of Dermatology revealed that disparities in case registrations of BCCs in Europe lead to an underestimation of approximately 30% of patients with a diagnosis of one or more BCCs and an underestimation of between 40% to 100% of the number of individual BCC tumours.

A high proportion of cases of BCC require extensive surgery to excise the tumour. Therefore, the determination of the true incidence of BCC is required to estimate the total costs associated with the management of this cancer type. The under-reporting of BCC leads to less accurate estimates of the true financial burden of surgical treatment, thus hindering service planning across Europe. The lack of adequate data regarding the costs of BCC management also limits the ability to produce targeted preventative health promotion campaigns, further emphasising the need for improved data collection.