Epidemiology of basal cell carcinoma in the Netherlands

This article discusses three recently published papers from the department of dermatology Erasmus Medical Centre Rotterdam on the epidemiology of basal cell carcinoma (BCC) in the Netherlands. The absolute numbers of patients in the Netherlands with first, histologically confirmed BCC increased with about a sevenfold in both men and women in the last 25 years (1973 - 2008). The lifetime risk for a BCC was 1 in 5-6 for Dutch citizens. Furthermore, almost one third of the patients with a first BCC will develop a second or more BCC(s) within five years, most often in the period directly following the first BCC. Based on data from PALGA, the Dutch nationwide network and registry of histo- and cytopathology, it was found that the incidence rate in the first six months following the first BCC diagnosis was 25.318 per 100.000 person-years. Although this figure remained high, it decreased to 6.953 per 100.000 person-years after five years of follow-up. Therefore, it was advised that BCC patients should always undergo full body skin examinations at first presentation and this should be repeated annually for at least three years. Results from a Dutch prospective population based cohort study showed that having red hair, being highly educated or when having a first BCC localized on the upper extremities were risk factors for developing multiple BCCs. Currently, in the Netherlands there is an ongoing socalled 'BCC epidemic'. The discussed results should urge Dutch healthcare policymakers to provide, in cooperation with dermatologists, solutions for the increasing number of patients with BCC(s).