Pattern of skin malignancies in patients presenting to dermatology department Hayatabad Medical Complex Peshawar.
Objective: This study was conducted to determine the pattern of cutaneous malignancies among patients attending the skin out-patient department Hayatabad Medical Complex Peshawar.
Methodology: This was descriptive analysis of skin cancers carried from January 2011 to December 2011. Histologically diagnosed skin cancers were reviewed and analyzed according to age, gender, site of distribution and histological types.
Results: Hundred histologically diagnosed skin malignancies were reported during the period under review. Sixty cases (60%) were males and 40 cases (40%) females with a male to female ratio of 1.5:1. Age ranged from 22 years to 86 years. Mean age was 57.05+_11.39 SD. Mean duration of disease in months were 16.78+_ 9.07SD. Basal cell carcinoma (BCC) was the most common malignancy consisting of 32(32%) cases followed by Squamous cell carcinoma (SCC 18%) with 10 (10%) cases of melanoma and 9(9%) cases of Mycosis Fungoides. Actinic Keratosis, Kaposi's sarcoma, Bowen's disease, Dermatofibroma, Atypical fibroxanthoma constituted the remaining.
Conclusion: The most common skin malignancy was BCC followed by SCC and melanoma. Larger studies should be conducted to ascertain the actual prevalence of skin tumors.
Key words: Cutaneous malignancies, Squamous cell carcinoma, Basal cell carcinoma, Melanoma, Kaposi's sarcoma.
Skin is the largest organ in human body. Cutaneous malignancies are estimated to represent 2030% of all malignancies in Caucasians, 2% to 4% in Orientals and1% to 2% of all cancers in Africans and Indians1. Among Caucasian population2,3 it has been recognized as the most common malignancy. In Singapore, skin cancer is ranked seventh in their cancer registery4.
Three most frequent primary skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma. BCC and SCC, in combination referred to as non melanoma skin cancers (NMSC), and malignant melanoma are common in white populations.1 The incidence of skin cancers has progressively increased particularly that of cutaneous melanoma over the last few decades.5. Incidence of NMSC is highest in Australia6 USA7 and in Finland8 BCC is more common. NMSC are not usually life threatening but morbidity is a main concern. In India, the incidence of skin malignancies is low constituting about 1-2% of all the diagnosed cancers. BCC in the commonest skin cancer worldwide, but various studies from India have reported SCC as the most prevalent skin malignancy. Studies regarding Cutaneous malignancies are very few and not been reported from KPK therefore this study is conducted to know the pattern of cutaneous malignancies in KPK.
This was a prospective study of all histologicallydiagnosed malignant skin lesions seen over a period of one year. Patient presenting to Hayatabad Medical Complex Dermatology outpatient department who were having suspected lesions were included in study. They were fully interviewed regarding their profession indoor or outdoor, application of any irritant or allergen, any collagen vascular disease history of trauma or secondary to burn. Lesions were biopsied and histopathology of lesion done. In addition, histopathology records of all malignancies during the study period which were referred from other departments of Hayatabad Medical Complex were reviewed and included in study to determine relative frequency of skin malignancies. Total of165 pt were send for biopsy and histopathology. Out of165 patients 100 patients turned out to be having skin tumours.
Hundred histologically diagnosed skin malignancies were reported during the period under review. Sixty cases were males and forty cases were females with a male to female ratio of 1:5.1. Age ranged from 22 years to 86 years. Mean age was 57.05+_11.39 SD. Mean duration of disease were 16.78 + 9.07 months. Out of sixty males thirty two were having BCC, 18 SCC, 10 Melanoma, 9 Mycosis Fungoides, 7 Actinic keratosis and rest were other rare cutaneous malignancies.(Table 1)
Out of forty female 14 were having BCC, 2 SCC, 2Melanoma, 3 Kaposi sarcoma, 3 Mycosis Fungoidies, rest were having rare cutaneous malignancies.
Non melanotic skin cancer was found to be more common between 4th to 9th decades. Melanoma was fount between 5-7th decade. Mycosis Fungoides was found in 4-7th decade while rest of tumours presented in different age groups. Dermatological malignancies were most commonly found in outdoor workers. (18 indoor versus 82 outdoor)
Site wise involvement was, Scalp in 8 patients, Face in 45 patients, trunk in 24 patients, upper limb in 17
Table 1: Pattern of Malignancies
###Acral lentigenous melanoma###3###3.0
###Malignant fibrous histocytoma###1###1.0
Table 2: Site of Malignancies
patients and lower limb in 6 patients.(Table 2)The most common age group for malignancy was41-80 years with 26 cases detected, followed by theage group 51-60 years with 20 cases. SCC was the most common consisting of 40 (40%) cases followed by BCC with 30 (30%) cases, and melanoma with 13 (13%) cases. Malignancy was present mainly in outdoor workers (82 versus 18). Most cases of non melonotic skin cancers were found in head and neck region among which face was found to be most common site for NMSC.
The incidence of skin cancer is under-estimated despite the ease and accessibility of the skin to clinical examination and biopsy procedures. In the absence of such data, the analysis of histopathology reports should provide a good reflection on the pattern of skin cancer in Khyber Pakhtunkhwa.
In our study, we noted that BCC is the commonest skin cancer followed by SCC, MM. In Singapore, Koh et al also noted that BCC was the commonest skin cancer in their study followed by SCC and MM.4 In our study CL was found to be 9% which is same as found in study done by Yap and Pubalan 11 which show 9.2% cutaneous lymphoma. BCC is commonly seen in males with a male to female ratio of 2: 112. In Australia, the incidence of BCC in those aged under 40 is higher in women than men, after which rates in men exceed women 13. However, different studies showed male predominance in skin malignancies which correlate with our study (1.5:1 ) .Male to female ratio was between 1.5 and 1.9 among the Singaporean and Chinese (4). CL is more common in males with a ratio of 2:1|14. MM has almost equal sex distribution among Japanese but more common in males among Singaporean Chinese4 15.Our study showed male predominance in case of cutaneous melanoma which may be due to our males which are mostly outdoor workers and females are mostly house wives and indoor worker. In Yapp and Pubalan study11, we noted that both these conditions were more common in females. Nevertheless, the number of patients in this study is small and might not be representative of the population in the whole state.
Skin cancer in Bahrain affected male above the age of 30 years with 70.2% of all patients
were above the age of 60 years old. This pattern among the Bahraini group is close to that in Saudi Arabia16,17. Our study showed malignancies to be more common in 4th to 8th decade, which is almost comparable. Present study also shows that 53% of the reported skin cancers were found in the head and neck region which demonstrate the major influence of sun exposure in the development of skin cancers. The frequency of skin cancers in men and women is different.Present study shows a male preponderance compa-rable to other studies.18,19 BCC was the commonest skincancer in the present series similar to study done byYap FBB.11 SCC commonly occurs on sun damaged skin. It can also arise in the precursor lesions such as Actinickeratosis, Bowen's disease, Leukoplakia or chronic ulcers/scars20. The most common histopathological pattern was the well differentiated form constituting 65% comparable to study by Alakloby et al.21
SCC ranked the second most frequent tumor after BCC which is comparable with other studies11,22. BCC in this series predominantly involved the face. Melanoma was the third most common lesion in the present study. Melanoma is the most lethal cutaneous malignancy. Although, it comprises about 3% of all skin cancers, it accounts for about 75% of all skin cancer
deaths14 The male preponderance is similar to the study by, Sharma et al.23 reported a higher male preponderance in India. Skin cancers arising from the cutaneous appendages are common
ut benign. As the region of head and neck is rich in appendages, they frequently arise in these areas. The other tumors rarely seen were dermatofibroma, atypical fibroxanthoma and Kaposi's sarcoma and actinic Keratosis.
Malignant skin lesions comprise a small but significant proportion of patients with cancer. BCC is the commonest histological variety unlike in western countries. The knowledge of the frequency of histopathological patterns can help in viewing the prognostic outlook for patients and planning an effective management.
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|Author:||Paracha, Mohammad Majid; Shah, Agha Ali; Khan, Mohammad Amjad; Khan, Safdar Ali|
|Publication:||Journal of Postgraduate Medical Institute|
|Date:||Mar 31, 2014|
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