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To the Editor: In their study of the incidence of basal cell and squamous cell carcinoma in persons younger than 40 years, Dr Christenson and colleagues¹ attribute the increased incidence of nonmelanoma skin cancer to increased UV exposure and decreased ozone protection. They discount a role of increased surveillance because the maximum and median tumor size did not decrease over time.

However, these measures may not reflect what is happening in the lower half of the size distribution (which would require knowing the mean and minimum sizes). Moreover, smaller size may not be the appropriate measure to detect increased surveillance because these lesions are already so small (generally <1 cm). Size might not even be relevant. The increased incidence may reflect recent patients having biopsies who would not have been examined in the past (ie, tapping into the existing reservoir of disease), a plausible explanation given that that the number . . . [Full Text of this Article]

Chad T. Wilson, MD
chad.t.wilson@dartmouth.edu
VA Outcomes Group
Vermont Veterans Affairs Medical Center
White River Junction

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