Critical revision of the management guidelines for non-melanoma skin cancer from a public health & economic perspective.

Skin cancer is by far the most frequent cancer worldwide and we modeled that the number of skin cancer patients will triple over the next 20 years. Non-melanoma skin cancer (NMSC) is responsible for about 90% of all skin cancers and originate from keratinocytes, called basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)). The remaining 10% of skin cancers are melanomas, arising from malignant degeneration of melanocytes and are responsible for more than 400 deaths a year in Belgium. Based on our previous research, a high economic burden of skin cancer in Belgium resulted in a total of €107 million in 2014 and a cumulative cost that will add up to €3.2 billion by 2034. Although they have a relatively benign course, NMSC account for 35.2% of these costs. Since their number and cost is predicted to triple by 2034 an evidence-based health economic approach is needed. Screening the population for NMSC does not add to lowering their cost. It is also clear that there is a lack of studies evaluating the health and cost-effectiveness balance of NMSC treatment and follow-up guidelines. With this project we will map the impact of NMSC on the quality of life, and characterise the natural behaviour of basal cell carcinomas in elderly. This will allow us to propose more cost-effective treatment procedures and follow-up regimens for these patients. The overall  goal is to develop high standard, quality of life- centred guidelines within the current budgetary constraints.