Skin Cancer in Western Saudi Arabia By Khalid M Al Aboud, MD Khalid M Al Aboud, MD Medical Director...

Skin Cancer in Western Skin Cancer in Western Saudi ArabiaSaudi Arabia

ByBy Khalid M Al Aboud, MDKhalid M Al Aboud, MD

Medical Director and Consultant Medical Director and Consultant Dermatologist,King Faisal Dermatologist,King Faisal

Hospital,Makkah.Hospital,Makkah.E-mail [email protected] [email protected]

IntroductionIntroduction::

There are few reports that focused on skin cancers in KSA 20-24.

The present study was undertaken to evaluate the spectrum of cutaneous cancer in the region of Taif by analyzing the data from patients seen in KFH.

ContinuedContinued……

In KFH, All patients from the periphery and the other major specialty hospitals of the city are referred as histopathology and oncology services are available only here.

Material and MethodsMaterial and Methods::

Records of newly diagnosed cases of skin cancer for a period of 10 years spanning 1992-2001 were obtained.

All the malignant skin lesions, either biopsied or excised, were included.


Details included computer registration number, age, sex, nationality, clinical description when available, provisional diagnosis, histopathology report and recommended treatment.

The figures were compared with those from the rest of Saudi Arabia and other states in the region.

ResultsResults::

104 cases of malignant cutaneous lesions, both primary and metastatic, were seen during the previous decade.

Saudi nationals comprised 101(70M,and 31F) and 3 were non-Saudis, one each from Yemen, Egypt and Syria.

M:F ratio of 2,25:1; non-Saudis were 1 male and 2 female.

AGE IN YEARS

DIAGNOSIS

<40 40-59 60-79 >80 TOTAL (%)

BCC 06 17 19 11 53 (50.96)

SCC03 06 12 06 27 (25.96)

MM01 04 07 01 13 (12.50)

Appendageal 01 --- 01 --- 02 (1.92)

Miscellaneos 01 01 01 01 04 (3.84)

Metastatic --- 01 03 01 05 (4.82)

TOTAL12 29 43 20 104 (100)


The noduloulcerative type of BCC was the Commonest type seen, next being the pigmented variety. Histopathological study frequently revealed solid type of BCC, at times with cystic degeneration.

Miscellaneous cancers constituted four; DFSP in 2, KS in 1 and the last with verrucous carcinoma.


Metastatic lesions were seen in five patients; in one it was postoperative following surgery for carcinoma of the gall bladder and in the other 4 cases the metastases were identified before the site of primary cancer was established.

DIAGNOSIS MEDIAN AGE

MALE:FEMAE RATIO

TOTAL (%)

BCC 65 2.5: 1 53 (50.96)

SCC 61 1.7: 1 27 (25.96)

MM 64 3.3: 1 13 (12.50)

Appendageal 45 1 : 1 02 (1.92)

Miscellaneous 60 3 :1 04 (3.84)

Metastatic 70 2 :3 05 (4.82)

DX HEAD AND NECK

UPPER LIMBS

LOWER LIMBS

TRUNK OTHERS TOTAL

(%)

BCC 47(88.67) 03(5.66) 01(1.88) 02(3.77) ----- 53 (100)

SCC 09(33.33) 05(18.51) 07(25.92) 02(7.40 04(14.81) 27 (100)

MM 02(15.38) 02(15.38) 06(46.15) 03(23.07) ----- 13 (100)

App 02(100) ----- ----- ----- ----- 02 (100)

Misc01(25.00) ----- 01(25.00) 02(50.00) ----- 04 (100)

Discussion:Discussion:

• In general, in KSA almost all known cancers have been seen to occur, though with some variations.

• Most of the previous epidemiological studies on cancer in the kingdom had been based on reports from different regions.

• It is only recently during the past 8 years that a National Tumor Registry has taken over this task of collecting information from all over Saudi Arabia.

Continued…Continued…

• In humans skin cancer is the most common with the risk increasing with longevity as seen by the observation that almost one half of those who live to 65 years of age get at least one skin cancer.

• There have been indications of increased incidence of skin cancer in the international literature and at least 700,000 new cases are diagnosed annually in the United States of America.


• Skin cancer ranks highest in the southern region of the kingdom with a M:F ratio of 2.4:1 as seen in the established literature .

• The age of our patients ranged between 6 to 110 years with a median age of 62.5 years.


• A slightly lower age has been recently reported from the northern part of the kingdom.

• When all dermatoses in the elderly were considered, skin cancers ranked the least common .


Geographical environment.

Genetic attributes .

Custom.


Although is more intense in the high altitude of Taif and more likely to predispose to skin cancer, the sunshine hours are less than other parts of the Kingdom, especially in the mountainous areas where clouds and fogs attenuate sunlight.

Study based Facts:Study based Facts:

(1)BCC: was seen in half the number of

patients in this study. In white populations it represents a figure

as high as 80% . was seen to predominantly involve the

face but could rarely involve any part of the body surface.


(2) SCC: ranked the 2ed commonest tumor after BCC

accounting for 25.96% in the current study.

3 of our patients developed SCC on preexisting skin lesions: two had Marjolin's ulcer and in another SCC had developed from gangrene in a diabetic foot.


(3) MM: represented 12.50% of the cutaneous

cancers in Taif region with a conspicuous M:F ratio of 3.3:1.


(4) Appendageal Tumors:

are common but usually benign.

Limited to head and neck area.


(5) Miscellaneous Tumors:

• rare .

• Tumors were seen include dermatofibrosarcoma protuberans, Kaposi's sarcoma and verrucous carcinoma.

Study based Facts:Study based Facts:(6) Metastatic Tumors:

5 cases had metastatic nodules on the skin.

Metastasis from a visceral carcinoma is uncommon with an estimated frequency between 5% to 10%. .

The most common primary tumors which metastasize to the skin are in the descending order cancers of the breast, lungs, kidneys, colon and other solid tumors .


(6) Metastatic Tumors:

In one of our patients the metastasis was the result of a therapeutic operative procedure but in the other four it could not be ascertained.

A high incidence of cutaneous metastases not only indicates a poor prognosis but more significantly, late diagnosis.

Skin Cancer in KSASkin Cancer in KSA

Reports that described the general pattern of cancers:

Commonest was skin cancer, SCC being most common.

Skin cancer was the most common one among females too in addition to males.



Skin cancer was 15th among other cancers.

SCC was commonest followed by BCC and MM .



In general, incidence of cancer was seen to be the lowest. Skin cancer was common in males.


Reports that focused on skin cancer:

22 cases of MM, 54%of them showed acral distribution. Tumors were on the foot or the head, advanced at diagnosis&rapidly fatal.

14 cases were reported of Kaposi sarcoma among 263 renal transplant recipients with incidence of 5.3%compared with an incidence of 0.4%in renal transplant recipients from western countries


Reports that focused on skin cancer:

137 cases of skin cancers were reported with mean age of 61 years .SCC was commonest followed by BCC&MM.

In retrospective study; 2 cases of MM were founded in one decade.

For the total Saudi population, the most common ten cancers are(1994-1996):

• Female breast cancer (8.8%), • Liver cancer (7.5%), • Leukemia (7.5%), • Non-Hodgkin's lymphoma

(7.3%) • Colo-rectum cancer (5.5%). • Thyroid cancer (5.2%), • Lung cancer (4.7%) • Nervous system cancer (3.9%) • Stomach cancer (3.8%) and • Urinary bladder cancer (3.5%)

GOALS

Health authorities may consider

1. Cancer Registry

2. Public education

3. Surgical Courses

Skin Cancer in Western Saudi Arabia By Khalid M Al Aboud, MD Khalid M Al Aboud, MD Medical Director...

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