Surgical treatment of keratinocyte carcinoma in Danish hospitals 2007-2021: Time trends and impact of patient and tumor characteristics on treatment choices.

The incidence of keratinocyte carcinoma (KC) is rising globally, significantly burdening healthcare resources. Treatment options include medical treatment, non-invasive procedures, and surgery, each associated with their distinct benefits and risks. With advanced treatment, the procedures become increasingly invasive for the patients and expensive for the society. This nationwide cohort study examined the current surgical treatment trends for KC, including factors influencing the likelihood of undergoing reconstructive surgery. We retrieved data on all first-time incidences of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) that were treated at a Danish hospital in the calendar years 2007-2021, corresponding to 34,205 patients with BCC and 17,625 patients with SCC. Descriptive statistics were used to study the development of reconstructive surgery, and the associations between demographic factors, tumor-related factors, and comorbidity, and the use of reconstructive procedures were analyzed using multivariable logistic regression. Among the patients, 26% with BCC and 35% with SCC received reconstructive surgery as part of their surgical treatment. The volume of surgical treatment increased with time, but the proportion of reconstructive procedures for surgically treated KC decreased in the study period. The likelihood of undergoing reconstructive surgery was higher for men and increased with age. Patients with BCC and high comorbidity burden or those who stayed in assisted living facilities were less likely to undergo reconstructive surgery. This was not the case for patients with SCC. The rapid increase in surgical treatment for KC at Danish hospitals, with a notable increase in reconstructive procedures, reflects the global development in KC cases and highlights the continued need for tailored management strategies.