Int J Dermatology - 2022 - Meijs - Burden of Skin Cancer in Colombia

Report
Burden of skin cancer in Colombia

Martijn Meijs1, MD, Astrid Herrera2, MSc, Alvaro Acosta3, MD and
Esther de Vries4, PhD
1
Department of Dermatology, Bovenij Abstract
Hospital Amsterdam, Amsterdam, the Background Levels of incidence and mortality of skin cancer in Colombia and Latin
Netherlands, 2The University of Antioquia,
America are largely unknown.
Antioquia, Colombia, 3Department of
Objectives Present the available information from official and gray literature and
Dermatology, Nacional Cancer Institute of
Colombia, Bogota , Colombia, 4Department governmental databases to grasp the magnitude and characteristics of skin cancer in
of Clinical Epidemiology and Biostatistics, Colombia (middle-income Latin American country).
Pontificia Universidad Javeriana, Bogota , Methods Narrative review based on a literature search (2005–2020), gray literature and
Colombia
cancer registry and governmental warehouse data, calculation of proportions and age-
Correspondence
standardized incidence (ASIR) and mortality rates (ASMR), expressed per 100,000 person-
Martijn Meijs, MD years.
Department of Dermatology Results ASIR of cutaneous melanoma in Colombia is around 3, corresponding ASMR
Bovenij Hospital Amsterdam between 0.7 and 0.8. Distinctive features are the high proportion and rates for acral
Amsterdam, the Netherlands
melanomas, and the advanced stage at diagnosis in the general population but not in
E-mail: mmmeijs@live.nl
private clinics. For non-melanoma skin cancer, ASIR is at least around 35–40, ASMR 0.8.
Location research conducted: Pontificia
Conclusions Among the wealthy Colombians, melanoma features are similar to those of
Colombia
Universidad Javeriana, Bogota high incidence countries (but of lower magnitude), whereas the majority of the population
present distinct features with a much higher proportion of acral melanomas, very late
Conflict of Interest: None. stages at diagnosis, and poor prognosis. More advanced melanomas seem to have a
relation with lower socioeconomic status. Non-melanoma skin cancer is common, with very
Funding source: None. high mortality rates at levels even above those of predominantly fair-skinned populations,
implying high fatality rates for non-melanoma skin cancers. This could indicate a late
diagnosis or difficulties in access to treatment, illustrating the need for primary and
doi: 10.1111/ijd.16077
secondary prevention to reduce the burden of disease and improve the prognosis of this
common cancer.
Colombia is a middle-income country in the North-West of

Introduction
South America, located close to the equator, with a tropical cli-
Skin cancer is classically seen as a disease of predominantly fair mate presenting variation within six natural regions depending
skin types (Fitzpatrick phototypes 1–3) and divided into two broad on the altitude. The ~49 million inhabitants are relatively young,
groups: cutaneous malignant melanoma (CMM) and non- and 6.5% of the population is aged 65 years or older. Health-
melanoma skin cancer (NMSC consisting of the keratinocyte can- care expenses are increasing; in 2014 this was USD 26.7 bil-
cers: squamous [SCC] and basal cell carcinomas [BCC], some- lion, 24% financed by the private sector.6 Healthcare insurance
times also including lymphomas, appendageal, fibromatous, and is divided into a premium-bound contributive scheme for
myomatous carcinomas).1,2 Very few reports are available on employees, retirees, and self-employed persons and a subsi-
skin cancer burden in predominantly more pigmented populations dized scheme for the unemployed or people with very low
(Fitzpatrick phototypes 4–6), probably because of their lower risk incomes. Those insured in the subsidized regime are in a small
because of their complexion and lower availability of cancer reg- majority compared to the contributory regime (47 and 43% of
istries.1–3 However, more pigmented people also develop skin the population, respectively). This out of a total of 95.4% of the
cancer, particularly if they live in areas with high ambient UV population that was insured in 2015.6 In addition, some people
exposure, such as those living close to the equator and/or at high have private insurance or pay out of pocket for medical atten-
altitudes.4,5 Additionally, many low-incidence countries have tion. The Colombian population consists of 58% mestizos (mix
important high-risk subpopulations, with sun-sensitive skin, scars, of European and American Indian descent), around 20% white
or use of immunosuppressive medication and living in tropical people, 14% mulattos (mix of European and African descent),
conditions or at high altitudes. 4% Afro-colombians, 3% mix of Afro and Indigenous descent, 1003
ª 2022 the International Society of Dermatology. International Journal of Dermatology 2022, 61, 1003–1011
13654632, 2022, 8, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/ijd.16077 by Cochrane Colombia, Wiley Online Library on [14/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1004 Report Burden of skin cancer in Colombia Meijs et al.
and around 1% Indigenous population.7,8 UV indices are usually populations. Original data were used to calculate in the same
above 10 (very strong). Fitzpatrick phototype distributions vary units to be comparable with the other literature. All rates are
geographically with, for example, phototypes 1–3 predominantly presented per 100,000 person-years.
seen in the country’s second-largest city, Medellin, and other Trends in mortality data were analyzed using the IARC
parts with main phototypes 5–6.9 cancer mortality database online analyses tool,21 using the
Sporadic reports on skin cancer, mainly melanoma, are avail- “breakpoint” option22 on the 20 -year period of 1996–2015. We
able for Colombia: an estimate on the burden of non-melanoma used joinpoint modeling to evaluate time trends and obtain
skin cancer (NMSC) was made based on medical consultations’ estimated annual percent change (EAPC) of the long-term
databases and many assumptions for the period 2003–2007.8 incidence data published in Cancer Incidence in 5 Continents –
Another study presented data on CMM from population-based PLUS,23 using the Seer*STAT Joinpoint Trend Analysis
cancer registries in Latin America.2 Reports from four individual Software.24 We applied a log-link and specified a maximum of
population-based cancer registries as well as specialized treat- two joinpoints with at least three datapoints on either end of the
ment centers are available.10–17 period of observation.
We aimed to integrate all available information on the burden
of CMM, SCC, and BCC for Colombia to provide a summary
Results
overview of the burden of skin cancer in Colombia and thereby
provide a framework for skin cancer surveillance and manpower Cutaneous malignant melanoma
planning in Colombia and similar countries in Latin America.
Incidence and mortality
ASIR and crude incidence rates of malignant melanoma (includ-
Materials and methods
ing extracutaneous melanomas) were estimated to be both
For this narrative review, three authors (MM, AH, and EdV) around 2–4 per 100,000, the incidence being slightly higher for
performed a search in Medline and SciELO in late 2020, on the females than males11,15–17 (Table 1, Fig. 1). Estimates for the
literature on descriptive epidemiology regarding incidence and year 2020 indicate that around 1800 new melanoma cases were
mortality of CMM, SCC, and BCC in Colombia published diagnosed.25 Melanoma ASMR for the period 2012–2016 for
between 2005 and 2020. Additionally, we scanned reference males was between 0.8 and 2.7 and for females was between
lists of the identified papers and searched for original sources 0.7 and 1.615–17,25 (Table 1, Fig. 1). The mortality trends
of information from mortality statistics, cancer registries, and between 1996 and 2015 show a statistically significant upward
semi-governmental administrative databases.18,19 trend with an EAPC of 3.02% (95% CI 2.33; 3.72) for males
Because of available population-based cancer registries with without a breakpoint and for females a non-statistically signifi-
good quality indicators, we included the data with respect to the cant increase between 1996 and 2008 with an EAPC of 1.67%
cities in Colombia which published data in the most recent (95% CI 0.87; 4.27), followed by a period of a statistically sig-
volume of cancer incidence in five continents11: Bucaramanga nificant increase of 3.29% (95% CI 0.57; 6.08).21 Of all mela-
(~0.55 million inhabitants, 786 km north of the equator, altitude noma deaths in this period, 86% were among residents of
1,189 m above sea level [ASL]), Pasto (~0.4 million inhabitants, relatively large cities, 3.6% among residents of small towns,
134 km north of the equator, and altitude 2,527 m ASL), and 10% in dispersed rural areas.19 The estimated mortality:in-
Manizales (~0.4 million inhabitants, 570 km north of the cidence ratio for melanoma in Colombia was 490/
equator, and altitude 2,150 m ASL), and Cali (~2 million 1805 = 0.27.25
inhabitants, 379 km north of the equator, and altitude 950 m One study specifically mentioned incidence rates of acral
ASL). More details of these cancer registries and their quality lentiginous melanomas (ALM) in the city of Bucaramanga during
indicators are available elsewhere.11,15–17 2000–2009, ASIR 0.26 for males and 0.33 for females.10
For CMM, we also included information on the CMM subtype Time-trends in incidence are difficult to assess because of
and anatomical subsite of private practice in an affluent the relative rarity of CMM in Colombia and additionally, only the
neighborhood in the capital city Bogota and compared these Cali registry has long-term data (since the 1960s) – joinpoint
with population-based data of Bucaramanga and Cali.3,12,14,15 analysis on these data showed a statistically significant increase
The incidence of acral lentiginous melanoma was compared in male melanoma incidence rates (EAPC 2.4%, 95% CI 1.0,
with published ethnicity-specific data from the USA.20 3.7%), while trends for females were stable (EAPC 0.7%, 95%
Where information on multiple periods was available of equal CI 0.2, 1.7%).16
data quality, we focused on the most recently available data
and where possible on population-based rather than institution- Anatomical subsite
based data. Where age-standardized incidence and mortality CMM in Colombia is characterized by a much lower proportion
rates (ASIR and ASMR) were reported, we only used the SEGI- of superficial spreading melanomas (SSM) and a much higher
standardized data to avoid confusion with other standard proportion of ALM compared to populations in the United States
International Journal of Dermatology 2022, 61, 1003–1011 ª 2022 the International Society of Dermatology.
Meijs et al. Burden of skin cancer in Colombia Report 1005
Table 1 Population-based Colombian melanoma incidence and mortality data if available
Incidence Mortality
CR ASR CR ASR
Population
Source and period M F M F M F M F
Uribe Bucaramanga 2.3 1.9 2.3 1.7 1.0 1.0 0.8 0.7
Perez CJ15 metropolitan
area
2008–2012
Bravo LE16 Cali 2008–2012 NA NA 2.8 2.6 2.7 1.6
for incidence, EAPC: EAPC:
2011–2015 2.2% 1.2%
for mortality (1.2;3.2) (0.1;2.5)
pez MC17
Ye Pasto 2.9 4.2 3.1 4.0 NA NA NA NA
2008–2012 PC between 2003–2007 and 2008–2012: +47.6% (males) and +25% (females)
Cancer Estimates for 3.0 4.1 2.6 3.1 0.95 0.98 0.81 0.70
today Colombia
202025 2020
ASR, age-standardized rate per 100,000 person-years (SEGI world population); CR, crude rate per 100,000 person-years; EAPC, estimates
annual percent change; F, female; M, Male; NA, not available; PC, percent change in ASR.
(Fig. 2). These ALMs occur typically on the palms of the hands, had no available stage information). Ulceration was present in
soles of the feet, and under the nails, very infrequent localiza- 31.1% of all patients (51.2% of those with available informa-
tions for high-incidence populations.10,13,20,23 The incidence tion).26 Reports from the Colombian High-Cost Account, within
rates by subsite were in the range of 0.01 (palms of hands) to principle population-wide coverage, have information by stage
0.73 per 100,000 for the lower limbs.10 at diagnosis available for the 80.3% of notified patients. In this
Private practice data from an affluent neighborhood in the group of patients with stage information, 51% were diagnosed
capital city of Bogota differ quite substantially from population- with in situ melanoma and 11% in stage I for the contributive
based data; a report from a private practice describes distribu- scheme, versus 16 and 25% in the subsidized scheme; similar
tions by localization and subtype with an important proportion proportions (14 vs. 13%) were diagnosed with stage IV disease –
on the head and neck and upper limbs and SSM and lentigo overall, 47% of all invasive CMMs were diagnosed in stages
maligna melanomas being the most important subtypes.12 By III–IV.18
contrast, the population-based information shows a concentra-
tion toward the lower limbs and nodular melanomas.2,10,13,26 Non-melanoma skin cancer
Both private and population-based data confirm the relatively Available incidence and mortality statistics for NMSC in Colom-
high proportion of ALM (Table 2). bian regions are shown in Figure 3. Estimates produced by
IARC, based on cancer registry data combined with regional
Clinical stage at diagnosis and other important mortality statistics, give an idea of the “minimum” NMSC ASIR
prognostic variables for Colombia in 2020: at least 5.8 for males and 3.9 for
Little population-based information is available on stage-related females25 – reflecting mostly SCC because BCC is not collected
variables, mostly because of the difficulties the registries experi- by most population-based cancer registries, except for the
ence in finding this information in the medical histories. The Pasto cancer registry.
Bucaramanga cancer registry made a special effort to complete Data provided by this Pasto Cancer Registry shows an ASIR
this information and could retrieve Breslow thickness for 41.4% for BCC of 22 for males and 29 for females; for SCC these fig-
of the patients; of those, 20.1% had a Breslow thickness of ures are 7.5 and 9.4, respectively27 (Table 3) – adding up to a
more than 2 mm. Ulceration was present for 24.3% of the 45% total ASIR NMSC of 29.5 and 38.4 for males and females,
of patients with available information for this variable.10 Recent respectively.
information on 132 CMM patients diagnosed between 2006 and A thesis based on the Bucaramanga cancer registry data lim-
2015 in Manizales showed that 76.5% had available information ited to SCC reports detailed information on 727 SCCs diag-
on Breslow thickness and 32.6% had a thickness of more than nosed between 2008 and 2012 – with ASIRs of 16.4 for males
2 mm; 27.3% were diagnosed in stages III–IV of all patients, and 7.7 for females. Of these SCCs, 65% occurred in the head
representing 41% of all patients with stage information (34.1% and neck region, 18% on the arms, 8% on the trunk, and 5%
Figure 1 Melanoma incidence rates for (a) males, (b) females, and (c) melanoma mortality rates in Colombia
on the legs. Importantly, 4.8% of SCCs were in the metastatic rates of CMM and SCC are slightly above the global average
stage at the time of diagnosis.28 but much lower than the more developed fair-skinned popula-
The ASMR for NMSC was 0.95 per 100,000 person-years for tions in Northwest Europe and Australia/New Zealand.25 A geo-
25
2020. Time trend evaluation of NMSC mortality rates showed graphically more similar population like Sicily, with 6 months per
a non-significant tendency for a slight decrease in trends (EAPC year UV indices above 7 shows two to four times higher mela-
0.1% for males [95% CI 1.5; 1.2%] and 1.1% for females noma incidence compared to Colombia.29 USA Hispanics had a
[ 2.7; 0.6%]). CMM ASIR (2000 US standard population) of 4.2, slightly higher
than Colombia.30–32 Part of the above-mentioned differences
may be explained by skin types, UV index, and geographic
Discussion
location, a likely under-diagnosis and subregistration of skin
Our results show that the numbers of skin cancer patients in cancer in Colombia, combined with a potential overdiagnosis in
Colombia are relatively high, considering it is a Latin American high-incidence countries.33 In Pasto, a high-altitude city very
(“low-risk”) population. near to the equator with a great part of the inhabitants with
Incidence rates of malignant melanoma (including extracuta- lighter skin types (Fitzpatrick phototypes 1–3), the NMSC inci-
neous melanomas) were around 2–4 per 100,000 with a slightly dence was substantially higher than those in Cali, a relatively
higher incidence for females compared to males and SCC nearby but lower altitude city with predominantly darker skin
roughly between 5 and 10.11,25 These Colombian incidence types (Fitzpatrick phototypes 5–6).34,35 The striking increase of
3.5 Acral Lenginous Melanoma incidence
Age-standardized incidence rate

3.0
per million person-years

3.0
2.5
2.5
2.0
1.5 1.8 1.8 1.8
1.0
1.1
0.5
0.0
USA Hispanic blacks

USA non-Hispanic
Bucaramanga
USA SEER
USA - Asian/Paciﬁc
USA Hispanic whites
Colombia,
Islanders
whites
The Surveillance, Epidemiology, and End Results (SEER)
Figure 2 Acral Lentiginous Melanoma incidence rate per million person-years
Table 2 Proportions of melanomas by characteristics Colombians with low income are less likely to be diagnosed
reported from private practice versus population-based with in situ or early-stage CMM, correlating with observations of
cancer registries in Colombia longer delays in the “poorer,” subsidized scheme of the health-
care security system to reach diagnosis and treatment compared
Private Bucaramanga Colombia to those with higher incomes (contributive scheme). The mean
Characteristics practice (14) (12) (3)
delay between initial symptoms and diagnosis was 49 days for
Location contributive patients, versus 66 days for subsidized, and the
Head and neck 39.8% 23.7% 25.3% mean time between diagnosis and initiation of treatment/surgery
Trunk 18.1% 11.2% 21.7% was 82 and 97 days, respectively.18 This coincides with the
Upper limbs 13.3% 16% 9.5%
poorer melanoma survival in the subsidized regime,10,18 although
Lower limbs 27.5% 42.6% 31.6%
the population-based CMM 5-year survival (68.7%) was not sta-
Unspecified 1.4% 6.5% 11.9%
Subtype tistically significantly related to the type of health insurance
ALM 17.8% 16.6% 15%a scheme. Point estimates for subsidized-insured patients were
SSM 42.2% 13.6% 7%a slightly lower, but differences may not have reached statistical
LM 33.3% 9.5% 7%a
significance because of the very small group of subsidized
NM 2.9% 24.3% 18%a
patients (they represented only 22% of the patient population).26
Others 2.4% 7.7% 2%a
Not specified 1.4% 28.4% 52%a Low socioeconomic status is also put forward as a possible
Ulceration factor for the higher mortality and later stage of diagnosis
Yes 5.1% 24.3% NA among Hispanics in the USA.30
No 56.1% 20.7% NA
The proportion of SSM is much lower and that of ALM higher
No information 38.8% 55% NA
than in predominantly fair-skinned populations. ALM incidence
ulceration
rates also seem to be higher. However, these distributions are
ALM, acrolentiginous melanoma; LM, lentigo maligna; NA, not avail- highly setting-specific. The report from private practice in
able; NM, nodular melanoma; SSM, superficial spreading melanoma. Bogota showed patterns much more similar to those from high-
a
Data for Cali only. incidence countries12; population-based information, including
the large less affluent part of the population, showed a concen-
melanoma incidence in men in Cali in the early 2000s and its tration toward the lower limbs and nodular melanomas.2,10,13 All
subsequent decline back to levels comparable to the other this detailed information must be interpreted with caution, as
PBCR was most likely because of registry artifacts, but the more than half of the CMM cases lacked information on detailed
exact reasons are unknown. subsite, stage, or morphology.
Figure 3 NMSC incidence rates for (a) males, (b) females, and (c) NMSC mortality rates in Colombia
The estimated mortality:incidence ratio for CMM in Colombia In high incidence countries, several factors are associated
(0.27) is almost double that of high-incidence countries,29 indi- with a late diagnosis of skin cancer, including lack of expertise
cating a relatively high case-fatality rate which aligns with (few dermatologists, little skin cancer knowledge among other
reports on poor melanoma survival.10,35,36 The high proportion physicians), high costs, waiting times for a medical appointment
of CMM patients (47%) diagnosed in stages III–IV is indeed or long distances by travel to reach a dermatologist38 – all of
indicative of a late diagnosis stage at diagnosis and/or very these are present in Colombia. In countries where family physi-
aggressive disease. Similarly, the ASMR for NMSC was high cians do skin cancer screenings, it has been described that
(0.95) compared to high incidence countries (0.23 [Netherlands] their sensitivity to detect skin cancer is below 60%.39
25
and 0.59 [USA]). This could imply that in Colombia many The Colombian Association of Dermatology and Dermatologi-
NMSC are diagnosed in late stages, which is in line with the cal Surgery estimates that Colombia has 1.25 dermatologists
4.8% of SCCs being diagnosed in the metastatic stage, a high per 100,000 inhabitants. These dermatologists are concentrated
number for population-based data. As an indicator, in a meta- in large cities, some of which have more than 3 dermatologists
analysis, the prevalence of positive sentinel lymph nodes per 100,000 inhabitants; whereas the supply in rural areas is
among high-risk SCC populations was 8% and among low-risk almost non-existent.40 This implies that in Colombia, a large
SCC populations, 0%.37 proportion of patients with dermatological diseases are under
Table 3 Estimates and reports of incidence and mortality of rates.1,45,46 It is likely that a significant proportion of NMSC in
non-melanoma skin cancer in Colombia Colombia are never diagnosed, and patients may die of other
causes or get diagnosed clinically and treated with non-invasive
Source ASIR ASMR methods, which makes it virtually impossible for cancer reg-
istries to identify these cases. As the survival of NMSC is quite
Sanchez8 Modeled based on diagnostic 34 (CR) NA
high, even without treatment, there may be many more cases
codes NMSC 2003–2007
Pasto Cancer SCC males 2008–2012 7.5 NA than are diagnosed and reported. The real incidence could
Registry26 SCC females 2008–2012 9.4 NA therefore be much higher than concluded from the currently
BCC males 2008–2012 22.1 NA available data.
BCC females 2008–2012 29.1 NA
The high NMSC mortality rates, which seem to be declining,
Cancer Today NMSC males 5.8 1.3
may be partial because of coding errors in the death certifi-
Estimates NMSC females 3.9 0.7
for Colombia cates. Certifying doctors may be unaware of the coding differ-
202025 ences between C43 and C44 coding, and a part of the
Bravo LE16 NMSC males 2008–2012 0.5 NA certificates may reflect CMM deaths – in which case the
Cali NMSC females 2008–2012 0.6 NA
increase observed in CMM mortality and the decrease in NMSC
Bucaramanga SCC males 2008–2012 16.37 NA
mortality may be because of an improvement in the quality of
cancer registry27 SCC females 2008–2012 7.69 NA
coding. However, without additional information, it is impossible
ASIR, age-standardized incidence rate per 100,000 person-years to quantify the extent of this coding error. The high proportion
(SEGI world population); ASMR, age-standardized mortality rate per of advanced stages at diagnosis among CMM and SCC gives
100,000 person-years (SEGI world population); CR, crude rate per credibility to the relatively high mortality rates.
100,000 person-years; NA, not available; NMSC, non-melanoma
In conclusion, skin cancer incidence in Colombia – close to
skin cancer.
the equator and with important proportions of the population liv-
ing at very high altitudes – seems to be substantially lower than
the care of general practitioners (6 years of basic medical train- in high incidence countries – probably because of the more pig-
ing) without further training,41 and probably with a lower sensi- mented population. However, this Latin American population
tivity than described for family physicians in high incidence does develop skin cancer, and in substantial amounts – partly
countries. because of ultraviolet exposure, partly because substantial sub-
The ability of family physicians in high-incidence countries to populations have sun-sensitive skin types. The presented inci-
make decisions for skin lesions that are potentially skin cancer dence rates probably underestimate the real skin cancer
varies greatly, and many lesions referred to dermatologists turn burden, particularly for NMSC. The prognosis of skin cancer in
out to be benign tumors (39%).42,43 Brief training to improve the Colombia is poor, maybe because of late diagnosis and the
ability of family physicians to recognize potential skin cancers more aggressive histological subtypes of melanoma present in
appears to increase their diagnostic accuracy.42 In countries this population.47,48 It seems difficult to recognize, refer, diag-
with a lower incidence of skin cancer, such as Colombia, the nose, and treat skin cancer in Colombia in a timely manner,
knowledge of general practitioners and the general population possibly related to lack of knowledge and awareness among
could be lower than in high incidence countries, because of this the general population as well as general practitioners but also
lower burden of skin cancer disease. It seems useful to improve because of difficulties in having timely access to specialists.
the knowledge and skills of family physicians and general practi- Apart from improving general medical knowledge about skin
tioners in recognizing suspected skin cancer lesions and to cancer and increasing awareness, there could be a place for
improve early detection.44 telemedicine and automatic learning algorithms to detect skin
cancer. This could help in providing access to dermatology
Limitations of the study care, even in remote areas, and also help the general practition-
The search for and registration of NMSC is difficult, as any- ers in getting better knowledge and reach earlier diagnoses,
where in the world.1,45,46 The available data from the which would be particularly of benefit to the more vulnerable
population-based cancer registries provide a minimum estimate part of the population.49
of the incidence of 8 per 100,000 person-years (all cases were
diagnosed with NMSC, mostly SCC, but it is likely that there is
Acknowledgments
underreporting of cases to the cancer registry). Data provided
directly by the Pasto Cancer Registry show subtype-specific We would like to thank all researchers working in the understud-
data with higher rates.27 ied field of skin cancer in Colombia and South America for pub-
Case-finding for NMSC cases by cancer registries is more lishing their data. Thanks to the Pasto cancer registry for
complicated than for CMM because of its outpatient and some- providing the information on non-melanoma skin cancer for this
times non-surgical management and very high recurrence work.
the United States, 1986–2005. Arch Dermatol 2009; 145: 427–

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Int J Dermatology - 2022 - Meijs - Burden of Skin Cancer in Colombia

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Int J Dermatology - 2022 - Meijs - Burden of Skin Cancer in Colombia

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Burden of skin cancer in Colombia

Colombia is a middle-income country in the North-West of

Table 1 Population-based Colombian melanoma incidence and mortality data if available

3.5 Acral Lenginous Melanoma incidence

Age-standardized incidence rate

per million person-years

1.5 1.8 1.8 1.8

USA Hispanic blacks

the United States, 1986–2005. Arch Dermatol 2009; 145: 427–

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