Management of non-melanoma skin cancer in England – patient activity: 2010 data based on inpatient cancer hospital episode statistics

Non-melanoma skin cancers (NMSC) are the most common group of cancers in England. 1 The most frequent types are basal cell and squamous cell carcinomas but the group also includes a number of rare cancers. The majority are managed as outpatients or day cases, others undergo procedures for extensive or invasive disease including reconstruction.

Hospital episode statistics (HES) data was used to identify NMSC (ICD10 C44) with an admission in 2010 (day and inpatient cases).

Data on procedures undertaken for skin cancer management including specialities involved, number of bed days for inpatients, age and first and second procedure codes were extracted. Cost assigned to healthcare resource groups (HRG) and cost of excess bed days were used to calculate total cost of spells.

The total number of admissions was 102,445. The average male to female case ratio was 1.4:1. The overall cost of NMSC management based on HES in 2010 was £80,092,999. Dermatology and plastic surgery services were associated with the highest cost for day and inpatient cases respectively but the recording of specialties involved in skin cancer care varied geographically in England. Sixty three per cent of excisions were for head and neck lesions. Fifty seven per cent of skin procedures (code prefix S) undertaken as a second procedure were related to reconstruction. The average inpatient stay in England was 4.3 days.

The use of HES data provided evidence of the amount of complex surgical repair and consequent cost taking place as part of the management of NMSC. Given the predicted increase in incidence of NMSC over the coming years in an ageing population it is essential that a better assessment of the level of care and cost involved, as well as public awareness of the disease, are achieved.