Transcript Retrospective study of skin cancers in Taif region, Saudi Arabia, in

Skin Cancer in Western Saudi
Arabia
By
Khalid M Al Aboud, MD
Medical Director and Consultant
Dermatologist,King Faisal Hospital,Makkah.
E-mail [email protected]
Introduction:
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.
Continued…
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 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.
Continued…
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.
Results:
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
<40
40-59 60-79 >80 TOTAL
(%)
BCC
06
17
19
11
53 (50.96)
SCC
03
06
12
06
27 (25.96)
MM
01
04
07
01
13 (12.50)
01
---
02
(1.92)
01
01
01
04
(3.84)
01
03
01
05
(4.82)
29
43
20
104 (100)
DIAGNOSIS
Appendageal 01
Miscellaneos
Metastatic
TOTAL
01
--12
---
Continued…
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.
Continued…
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
2 :3
05 (4.82)
70
DX
HEAD AND
NECK
UPPER
LIMBS
LOWER
LIMBS
TRUNK
03(5.66)
01(1.88)
OTHERS
TOTAL
(%)
02(3.77)
-----
53 (100)
BCC
47(88.67)
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)
Misc
01(25.00)
-----
01(25.00)
02(50.00)
-----
04 (100)
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…
• 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.
Continued…
• 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.
Continued…
• 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 .
Continued…
Geographical environment.
Genetic attributes .
Custom.
Continued…
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:
(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.
Study based Facts:
(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.
Study based Facts:
(3) MM:
 represented 12.50% of the cutaneous
cancers in Taif region with a conspicuous
M:F ratio of 3.3:1.
Study based Facts:
(4) Appendageal Tumors:
 are common but usually benign.
 Limited to head and neck area.
Study based Facts:
(5) Miscellaneous Tumors:
•
rare .
•
Tumors were seen include
dermatofibrosarcoma protuberans,
Kaposi's sarcoma and verrucous
carcinoma.
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 .
Study based Facts:
(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 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 in KSA
 Reports that described the general
pattern of cancers:
Skin cancer was 15th among other
cancers.
SCC was commonest followed by BCC
and MM .
Skin Cancer in KSA
 Reports that described the general
pattern of cancers:
In general, incidence of cancer was seen
to be the lowest. Skin cancer was common
in males.
Skin Cancer in KSA
 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
Skin Cancer in KSA
 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