Guest commentary: Disease management: Skin cancer incidence, prevalence on the rise

January 1, 2009

During the Congress of the European Academy of Dermatology and Venereology, the European Society for Micrographic Surgery discussed the growing problem of skin cancer. We would like to share our thoughts about the increasing number of skin cancer patients and how to deal with this problem.

Key Points

De Vries et al estimated that, in Europe, the incidence in this subgroup would be doubled in 2015 compared to 2000, from 322 incident cases in 2000 to 676 incident cases in 2015.2

Healthcare burden

The burden for the healthcare system is increasing enormously. In the Netherlands, dermatologists already spend 50 percent of their time on patients with pre-malignancies.

Nonmelanoma skin cancer has been considered a negligible health problem for a long time, because of low mortality. However, morbidity and the burden for the healthcare system are high, as are the costs related to skin cancer.4

In America, skin cancer takes the fifth position with respect to cost, behind prostate, lung and bronchus, colon and rectum and breast carcinomas.5

In Germany, the age-specific proportion of nonmelanoma skin cancer (NMSC) hospitalizations considerably increased with age. The annual hospitalization costs for melanoma were about 50 million to 60 million euro; for NMSC, this was 105 million to 130 million euro.4

Disease management

To manage the future costs and quality of care for this growing number of patients, a new health strategy must be developed.

For chronic diseases, such as diabetes and heart failure disease, management systems exist.6,7 A disease management system provides a systematic approach to a healthcare problem, and is best applicable for large patient groups with standardized diagnostic examination and treatment schemes.8

A disease management system makes adjustments in healthcare across all fronts - prevention, secondary prevention, efficient diagnostic examination, the use of standardized treatment schemes, the help of special trained nurses and support modern information technology.

Primary prevention

Primary prevention remains very important to decrease the number of new patients in the future. A strong collaboration between general practitioners and specialists is necessary for early detection and more efficient healthcare.

Nurse practitioners play an important role in educating patients, explaining treatments and supporting patients during treatments.

The whole system is supported by a special information technology system. This system must be proactive, and it should give diagnostic and treatment advice according to the guidelines. It should also give alerts if a patient has allergies, for example.


In addition, the system should be able to provide communication between healthcare workers. For example, nurses need to be reminded if a new follow-up appointment needs to be made. On top of this, management strategies should be applied to achieve high-quality healthcare and identify cost savings.

We believe that a structured disease management program will help dermatologists to deal with the enormous burden of skin cancer patients.