Lower socioeconomic status is related to higher risk of locally advanced (≥T2) BCC and SCC.

Male sex and older age are equally related to a higher risk of ≥T2 tumors.

Early detection and treatment should be prioritized for vulnerable individuals.

Most keratinocyte carcinomas (KC) are localized and slow-growing. However, for some patients, KC can become locally advanced lesions and cause substantial tissue damage that require extensive surgery to manage. We wanted to explore risk factors for locally advanced disease with the overall aim to offer more timely diagnosis and treatment.

This nationwide, register-based cohort study examined the association of demographic factors, educational level, disposable income, cohabitating status, comorbidity, and region of residence with tumor (T) category for patients with a first-time diagnosis of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) from 2007 to 2021, using multivariable logistic regression analyses.

We identified 166,467 BCC and 36,609 SCC patients. Male sex, old age, lower educational level and disposable income, living alone, and comorbidity were linked to higher odds of developing a ≥T2 tumor. Residence outside the Capital Region increased the risk of locally advanced BCC, while the risk of locally advanced SCC was higher in the Zealand, Central, and Northern regions.

There are significant associations between socioeconomic status, comorbidity, and region of residence and the risk of developing ≥T2 tumors in both BCC and SCC. Efforts to enhance early detection and treatment should focus on vulnerable individuals.

Basal cell carcinoma

Squamous cell carcinoma

Cancer stage

Socioeconomic factors

Early cancer detection

© 2025 The Authors. Published by Elsevier Ltd.