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BACKGROUND: Mucosa melanoma is a rare condition with aggressive behavior and a less favorable prognosis compared to cutaneous melanoma. The objective of this study was to estimate the overall survival and clinical outcomes of patients diagnosed with mucosal melanoma in a Colombian hospital. METHODS: A retrospective cohort study was conducted at Fundación Valle del Lili, a single center located in Cali, Colombia. Patients aged ≥ 18 years, both sexes, diagnosed with mucosal melanoma by histopathology study were included between 2010-2019. Patients who received extra-institutional treatment or whose vital status was unknown during follow-up were excluded. Demographic, clinical and laboratory data were obtained from medical records and laboratory and pathology databases. A descriptive analysis was performed. Survival analysis was conducted using the Kaplan-Meier method. RESULTS: A total of 23 patients were included. Median age was 63 years old (IQR: 57-68) and 52.2% were woman. Clinical stage was 34.8% early, 26.1% locally advanced and 39.1% metastatic. The main primary locations were nasopharynx (30.4%), genitals (26.1%), rectum (21.7%), oral cavity (13%) and paranasal sinuses (8.7%). The majority received surgery (30.4%) and immunotherapy (26.1%) as first line treatment. Overall survival at one year was 80.8%, at three years 44.3%, and at five years 36.9%. CONCLUSION: Mucosal melanoma is a rare, aggressive disease with adverse oncological outcomes due to late diagnosis and limited treatment options. This study provides real-world data in a single-center of Colombia.
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Melanoma , Membrana Mucosa , Humanos , Melanoma/mortalidad , Melanoma/patología , Melanoma/terapia , Melanoma/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Colombia/epidemiología , Anciano , Membrana Mucosa/patología , Pronóstico , Tasa de Supervivencia , Estadificación de Neoplasias , Estimación de Kaplan-MeierRESUMEN
INTRODUCTION: The worldwide incidence of melanoma has increased in the last 40 years. Our aim was to describe the clinic-pathological characteristics and outcomes of three cohorts of patients diagnosed with melanoma in a Latin-American cancer institute during the last 20 years. METHODS: We evaluated three retrospective patient cohorts diagnosed with melanoma at Instituto Nacional de Enfermedades Neoplasicas (INEN), a public hospital in Lima, Peru, for the years 2005-2006, 2010-2011, and 2017-2018. Survival rate differences were assessed using the Log-rank test. RESULTS: Overall, 584 patients were included (only trunk and extremities); 51% were male, the mean age was 61 (3-97) years, and 48% of patients resided in rural areas. The mean time to diagnosis was 22.6 months, and the mean Breslow thickness was 7.4 mm (T4). Lower extremity was the most common location (72%). A majority of the patients (55%) had metastases at the time of presentation, with 36% in stage III and 19% in stage IV. Cohorts were distributed as 2005-2006 (n = 171), 2010-2011 (n = 223), and 2017-2018 (n = 190). No immunotherapy was used. Cohort C exhibited the most significant increase in stage IV diagnoses (12.3%, 15.7%, 28.4%, respectively; p < 0.01). The median overall survival rates at the three-year follow-up demonstrated a decline over the years for stages II (97%, 98%, 57%, respectively; p < 0.05) and III (66%, 77%, 37%; p < 0.01). CONCLUSIONS: There has been a worsening in the incidence of late-stage metastatic melanoma in Peru throughout the years, coupled with a significant decline in overall survival rates. This is underscored by the fact that half of the population lives in regions devoid of oncological access.
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Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/patología , Melanoma/epidemiología , Melanoma/mortalidad , Masculino , Persona de Mediana Edad , Femenino , Anciano , Estudios Retrospectivos , Tasa de Supervivencia , Adulto , Anciano de 80 o más Años , Adulto Joven , Adolescente , Perú/epidemiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/epidemiología , Estudios de Seguimiento , Niño , Preescolar , Pronóstico , Incidencia , Disparidades en Atención de Salud , América Latina/epidemiologíaRESUMEN
Malignant melanoma is considered the most aggressive skin cancer due to its rapid evolution and risk of metastasizing. Early diagnosis and treatment can save the patient's life, and the biological factors of each melanoma subtype must be studied for better patient management. Currently, it is known that nodular subtype melanoma is the most aggressive due to its rapid vertical evolution, with a minor epidermal component but an important dermal component, which increases the risk of lymph node and hematogenous metastasis. Clinical, histopathological, dermoscopic and biological characteristics can help with the diagnosis and subsequent treatment of these patients
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Humanos , Masculino , Femenino , Melanoma/diagnóstico , Melanoma/patología , Melanoma/prevención & control , Melanoma/epidemiologíaRESUMEN
Increased genetic risk for melanoma can occur in the context of germline pathogenic variants in high-penetrance genes, such as CDKN2A and CDK4, risk variants in low- to moderate-penetrance genes (MC1R and MITF), and possibly due to variants in emerging genes, such as ACD, TERF2IP, and TERT. We aimed to identify germline variants in high- and low- to moderate-penetrance melanoma risk genes in Brazilian patients with clinical criteria for familial melanoma syndrome. We selected patients with three or more melanomas or melanoma patients from families with three tumors (melanoma and pancreatic cancer) in first- or second-degree relatives. Genetic testing was performed with a nine-gene panel (ACD, BAP1, CDK4, CDKN2A, POT1, TERT, TERF2IP, MC1R, and MITF). In 36 patients, we identified 2 (5.6%) with germline pathogenic variants in CDKN2A and BAP1 and 4 (11.1%) with variants of uncertain significance in the high-penetrance genes. MC1R variants were found in 86.5%, and both red hair color variants and unknown risk variants were enriched in patients compared to a control group. The low frequency of germline pathogenic variants in the high-penetrance genes and the high prevalence of MC1R variants found in our cohort show the importance of the MC1R genotype in determining the risk of melanoma in the Brazilian melanoma-prone families.
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Melanoma , Neoplasias Cutáneas , Humanos , Brasil/epidemiología , Predisposición Genética a la Enfermedad , Melanoma/epidemiología , Melanoma/genética , Melanoma/patología , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Pruebas Genéticas , Mutación de Línea Germinal , Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , Receptor de Melanocortina Tipo 1/genéticaRESUMEN
BACKGROUND: Melanoma is the most lethal skin cancer, and its incidence has increased worldwide. About 10% of cases are classified as hereditary melanoma (HM). CDKN2A and CDK4 are the major high-risk genes. Families are also more prone to develop pancreatic cancer, and different forms of oncological surveillance are recommended. OBJECTIVES: Describe the prevalence of CDKN2A/CDK4 germline mutations in melanoma-prone patients and their phenotypic and histopathological features. METHODS: A total of 69 patients meeting the clinical criteria for HM were included in this cross-sectional descriptive study. Amplification by PCR and genomic sequencing were used. The variants were classified according to American College of Medical Genetics (ACMG) criteria. RESULTS: The mean age at first diagnosis of melanoma was 44.8 years (SD ± 17.83). Most patients had phototype II (44.9%), more than 50 melanocytic nevi (76.8%), atypical nevus syndrome (72.5%), history of sunburn (76.8%), and multiple primary melanomas without a family history of this tumor (74.3%). Two hundred melanomas were observed. Most tumors had a Breslow index ≤1.0 mm (84.5%), location in the trunk (60.5%), and superficial spreading histological subtype (22.5%). Four variants were found in CDKN2A exons in seven patients (c.305C>A, c.26T>A, c.361G>A e c.442G>A), two variants in the 5'UTR region in five patients (c.-25C>T and c.-33G>C), and two variants in the 3'UTR region in 21 patients (c.*29C>G and c.*69C>T). One likely pathogenic variant (c.305C>A) was identified in one patient (1.4%). No variant was found in CDK4. CONCLUSION: The prevalence of CDKN2A mutations was 1.4% in Brazilian patients meeting clinical criteria for HM.
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Melanoma , Neoplasias Cutáneas , Humanos , Adulto , Brasil/epidemiología , Estudios Transversales , Quinasa 4 Dependiente de la Ciclina/genética , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Melanoma/epidemiología , Melanoma/genética , Melanoma/patología , Mutación de Línea Germinal , Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , Predisposición Genética a la Enfermedad , Melanoma Cutáneo MalignoRESUMEN
To describe the population with early malignant melanoma, we performed a cohort study on the basis of the Epidemiological Registry of Malignant Melanoma in Colombia-Asociacion Colombiana de Hematologia y Oncologia. From January 2011 until December 2021, 759 patients were included; the average age was 66 years, 57% were women, acral lentiginous histology was found in 27.8% of patients, and the median follow-up was 36.5 months. The prognostic factors for overall survival in our population are Eastern Cooperative Oncology Group 3-4 (hazard ratio [HR], 13.8), stage III (HR, 5.07), received radiotherapy (HR, 3.38), ulceration on histology (HR, 2.68), chronic sun exposure (HR, 2.3), low income (HR, 2.04), previous local surgery (HR, 0.27), and have received adjuvant treatment (HR, 0.41).
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Melanoma , Humanos , Femenino , Anciano , Masculino , Estudios de Cohortes , Pronóstico , Colombia/epidemiología , América Latina , Melanoma/diagnóstico , Melanoma/epidemiología , Melanoma/terapia , Sistema de Registros , Melanoma Cutáneo MalignoRESUMEN
Background People affected by Human Immunodeficiency Virus (HIV), are burdened by a higher risk of developing malignancies including non-melanoma skin cancer (NMSC) and melanoma skin cancer. Objective To evaluate the association of HIV with melanoma and NMSC at a University Hospital. Methods This is a cross-sectional retrospective study of HIV-infected and a matched comparison group, analyzing the associations between skin cancer and HIV infection. Results Compared to the HIV-uninfected, HIV-infected had 80% association with skin cancer (CI 95%: 1.3-2.4, P = 0.001) The risk was 45-fold higher by patients" age (CI 95%: 3.3-15.9: P = 0.001). When adjusted for patient age, sex and race, the risk was 6.4 fold ligher of having cancer if compared to the others (CI 95%: 49-84, P = 0.001). Melanoma was not found in HIV-infected. Conclusion With this study, we have demonstrated that HIV-infected patients have an increased risk of BCC and SCC. Preventive dermatologic management is pivotal in the care of immunosuppressed patients. These patients must undergo the dermatological examination annually and should receive extensive counseling regarding sun avoidance, use of sunscreens,and sun-protective clothing.
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Carcinoma Basocelular , Carcinoma de Células Escamosas , Infecciones por VIH , Melanoma , Neoplasias Cutáneas , Humanos , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Carcinoma Basocelular/complicaciones , Estudios Retrospectivos , Estudios Transversales , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etiología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Melanoma/diagnóstico , Melanoma/epidemiología , Melanoma/complicaciones , Factores de RiesgoRESUMEN
OBJECTIVE: This study aimed to analyse the clinical and histopathological characteristics of focal oral melanocytic lesions in a Brazilian reference service in Oral and Maxillofacial Pathology. MATERIALS AND METHODS: A cross-sectional study was conducted over an 18-year period. Demographic data and clinical features were collected from the archives, and all biopsy specimens diagnosed as oral melanocytic lesions were retrieved and reviewed. RESULTS: We identified 339 melanocytic lesions. Of these, 191 were melanotic macules, 112 melanocytic nevi, 14 mucosal lentigo simplex, 12 melanomas, 9 solar lentigos, and 1 melanoacanthoma. Lesions occurred mostly in white-skinned (74.2%) women (65.2%). The main reported clinical aspect was the macule (67.4%), and the most affected site was the lip vermilion (25.4%), followed by the palate (22.9%). Melanomas were larger in size and were observed in older patients with an overall shorter time of onset. The most frequent subtypes of melanocytic nevi were intramucosal (44.6%), compound (24.1%), and blue nevus (20.5%). They showed a heterogeneous architectural pattern with the presence of the three cell types. CONCLUSION: The most frequent lesions are melanotic macule and nevus, especially the intramucosal subtype. Patients are usually white-skinned women presenting a small, long-lasting, macular lesion on the lip vermilion or palate.
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Melanoma , Nevo Pigmentado , Neoplasias Cutáneas , Humanos , Femenino , Anciano , Masculino , Mucosa Bucal/patología , Estudios Transversales , Nevo Pigmentado/epidemiología , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patología , Melanoma/epidemiología , Melanoma/diagnóstico , Melanoma/patologíaRESUMEN
BACKGROUND: The COVID-19 lockdown possibly meant a delay in the diagnosis and treatment of melanoma and therefore, worsening its prognosis. This unique situation of diagnosis deferral is an exceptional opportunity to investigate melanoma biology. OBJECTIVES: To evaluate the immediate and mid-term impact of diagnosis delay on melanoma. METHODS: A retrospective observational study of melanoma diagnosed between March 14th 2019 and March 13th 2021. We compared the characteristics of melanomas diagnosed during the first 6-month period after the lockdown instauration and a second period after recovery of normal activity with the same periods of the previous year, respectively. RESULTS: A total of 119 melanomas were diagnosed. There were no differences in age, sex, incidence, location, presence of ulceration or mitoses, and in situ/invasive melanoma rate (p>0.05). After the recovery of the normal activity, Breslow thickness increased in comparison with the previous year (2.4 vs 1.9mm, p<0.05) resulting in a significant upstaging according to the AJCC 8th ed. (p<0.05). STUDY LIMITATIONS: The main limitation is that this is a single-center study. CONCLUSIONS: The COVID-19 lockdown implied a diagnosis delay leading to a mid-term increase in Breslow thickness and an upstaging of invasive melanomas. However, the detection deferral did not result in a higher progression of in situ to invasive melanoma, in our sample.
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COVID-19 , Melanoma , Neoplasias Cutáneas , Humanos , COVID-19/epidemiología , Control de Enfermedades Transmisibles , Melanoma/diagnóstico , Melanoma/epidemiología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Pronóstico , Estudios Retrospectivos , Melanoma Cutáneo MalignoRESUMEN
BACKGROUND: Malignant melanoma (MM) is the most fatal cutaneous neoplasm. Its incidence is increasing progressively, which cannot be explained only by early diagnosis. Chilean population, due to the geography of the country, has a very varied solar exposure. AIM: To know the incidence of MM in a Chilean population, according to the level of sun exposure and to describe its clinical and histopathological characteristics. MATERIAL AND METHODS: Two hundred seventy-four surgeries for malignant melanoma with histological confirmation, carried out between 2016 and 2018 in an oncological institute were included. RESULTS: The annualized incidence of MM was 13.83 cases per 100,000 people over 15 years of age in the 2016-2018 period. The geographical distribution of the incidence did not have a clear relationship with sun exposure. The most frequent locations of the primary lesions were trunk, head/neck and lower limb. Sixty-one per cent of cases were invasive MM; lesion thickness and presence of ulceration were associated with a higher risk of sentinel node involvement. CONCLUSIONS: No association between the level of sun exposure and the incidence of MM was observed in this study.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/epidemiología , Melanoma/patología , Melanoma/epidemiología , Chile/epidemiología , Incidencia , Distribución por Edad y Sexo , Ganglio Linfático CentinelaRESUMEN
OBJECTIVE: Malignant cutaneous melanoma is the most aggressive type of skin cancer, and its early detection and prompt initiation of treatment play an important role in reducing disease-associated morbidity and mortality. Many factors influence the diagnosis of melanoma, and its recognition is essential for the development of strategies for its early detection. This study was carried out to Identify the main variables related to the delay in diagnosis of Malignant Cutaneous Melanoma and correlate them with the time interval for making the definitive diagnosis. METHODS: Retrospective analysis of 103 patient records from January 2015 to December 2020 correlating social, economic, demographic, and cultural factors with the time elapsed between the onset of symptoms and the diagnosis of malignant cutaneous melanoma. RESULTS: The average time to seek medical services from the onset of symptoms was 29.54 months. The mean time for a referral from the primary to the referral service was 1.35 months, and the factors that contributed to a faster diagnosis were lesion Breslow (>1 mm), lesion growth, income range (≤1.5 minimum wages), lower phototypes (I and II), not having gone to the Basic Healthcare Units, profession (household), smoking, and type of housing. CONCLUSIONS: Our findings demonstrate that there is still a great delay in the recognition of signs and symptoms related to the diagnosis of malignant cutaneous melanoma in our country, influenced by several socioeconomic and demographic factors.
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Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/diagnóstico , Melanoma/epidemiología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , Estudios Retrospectivos , Diagnóstico Tardío , Factores de Tiempo , Factores Socioeconómicos , Demografía , Melanoma Cutáneo MalignoAsunto(s)
COVID-19 , Melanoma , Neoplasias Cutáneas , Brasil/epidemiología , COVID-19/epidemiología , Prueba de COVID-19 , Hospitales Universitarios , Humanos , Melanoma/diagnóstico , Melanoma/epidemiología , Pandemias , SARS-CoV-2 , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Melanoma Cutáneo MalignoRESUMEN
OBJECTIVE: We estimated the cutaneous melanoma (CM) incidence, mortality, and survival in Manizales, Colombia to establish predictors for survival. METHODS: This analytical cohort study used CM incident cases during 2006 to 2015 in the Manizales Cancer Registry (n = 132). Incidence and mortality rates were standardized using the direct method. Patients were followed up until 30 November 2020. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the log-rank test for differences. Cox multivariate regression models were fitted. RESULTS: Incidence (per 100,000) increased from 1.6 to 3.0 in men and 2.6 to 2.8 in women during 2006-2010 to 2011-2015, respectively. Mortality was low and stable. Five-year survival was 68.7%, with significant differences according to age (hazard ratio [HR] >70 vs. ≤70 years: 3.37); histological subtype (HR for melanoma not otherwise specified and HR for nodular melanoma vs lentigo malignant melanoma and superficial spreading melanoma: 17.39 and 10.16, respectively); and clinical stage (HR stages III-IV vs. stages I-II: 5.94). CONCLUSION: CM is characterized by increasing incidence and unfavorable prognosis, particularly in patients aged >70 years, with melanoma not otherwise specified and nodular melanoma, and advanced stages. Promoting photoprotection and early detection and management of suspicious skin lesions is crucial.
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Melanoma , Neoplasias Cutáneas , Estudios de Cohortes , Colombia/epidemiología , Femenino , Humanos , Incidencia , Masculino , Melanoma/diagnóstico , Melanoma/epidemiología , Pronóstico , Neoplasias Cutáneas/patología , Tasa de Supervivencia , Melanoma Cutáneo MalignoRESUMEN
Objetivo: Determinar el comportamiento epidemiológico y anatomopatológico del melanoma uveal. Método: Estudio descriptivo, longitudinal y retrospectivo en pacientes enucleados por diagnóstico de melanoma uveal en el Centro Oftalmológico de Villa Clara entre enero de 2010 a mayo de 2021. Resultados: La edad media de presentación del melanoma uveal fue de 61,3 años. Las mujeres fueron ligeramente más afectadas que los hombres-56,3 por ciento. El 81,3 por ciento de los melanomas uveales se originó en la coroide. Los tumores de células epitelioides y fusiformes fueron los más representativos; ambos con un 37,5 por ciento. El grosor y diámetro basal medio en los tumores estudiados fue de 11,2 mm y 15,8 mm respectivamente; prevalecieron los tumores medianos con un 56,3 por ciento. Se encontró infiltración tumoral en 37,5 por ciento de los ojos, la infiltración escleral fue la más frecuente. Conclusiones: El melanoma uveal se presenta con mayor frecuencia en personas con edad avanzada y en la coroide. El estudio histológico confirma el diagnóstico en la totalidad de los casos. Aproximadamente 2/3 de los tumores con algún grado de infiltración son grandes y la mitad de células epitelioides(AU)
Objective: To determine the epidemiologic and anatomopathologic behavior of uveal melanoma. Methods: Descriptive, longitudinal and retrospective study in patients enucleated for diagnosis of uveal melanoma in the Ophthalmologic Center of Villa Clara from January 2010 to May 2021. Results: The average age of presentation of uveal melanoma was 61.3 years. Women were slightly more affected than men-56.3 percent. 81.3 percent of uveal melanomas originated in the choroid. Epithelioid and spindle cell tumors were the most representative; both with 37.5 percent. The average thickness and basal diameter of the tumors studied were 11.2mm and 15.8mm respectively; medium-sized tumors prevailed with 56.3 percent. Tumor infiltration was found in 37.5 percent of the eyes, scleral infiltration was the most frequent. Conclusions: Uveal melanoma occurs more frequently in people with advanced age and in the choroid. Histological study confirms the diagnosis in all cases. Approximately 2/3 of the tumors with some degree of infiltration are large and half are epithelioid cells(AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias de la Úvea/patología , Melanoma/epidemiología , Epidemiología Descriptiva , Estudios LongitudinalesRESUMEN
BACKGROUND: Levels of incidence and mortality of skin cancer in Colombia and Latin America are largely unknown. OBJECTIVES: Present the available information from official and gray literature and governmental databases to grasp the magnitude and characteristics of skin cancer in Colombia (middle-income Latin American country). METHODS: Narrative review based on a literature search (2005-2020), gray literature and cancer registry and governmental warehouse data, calculation of proportions and age-standardized incidence (ASIR) and mortality rates (ASMR), expressed per 100,000 person-years. RESULTS: ASIR of cutaneous melanoma in Colombia is around 3, corresponding ASMR between 0.7 and 0.8. Distinctive features are the high proportion and rates for acral melanomas, and the advanced stage at diagnosis in the general population but not in private clinics. For non-melanoma skin cancer, ASIR is at least around 35-40, ASMR 0.8. CONCLUSIONS: Among the wealthy Colombians, melanoma features are similar to those of 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 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 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 secondary prevention to reduce the burden of disease and improve the prognosis of this common cancer.