Skin Cancer in Western Saudi Arabia by sammyc2007


									Skin Cancer in Western Saudi

             Khalid M Al Aboud, MD
        Medical Director and Consultant
    Dermatologist,King Faisal Hospital,Makkah.
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.

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.
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.
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)
Appendageal 01       ---   01   ---   02   (1.92)
Miscellaneos   01    01    01   01    04   (3.84)
Metastatic     ---   01    03   01    05   (4.82)
TOTAL          12    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.
             AGE      RATIO        (%)
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)
       HEAD AND    UPPER       LOWER       TRUNK                   TOTAL
 DX    NECK        LIMBS       LIMBS                   OTHERS

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

       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)
• In general, in KSA almost all known cancers
  have been seen to occur, though with some
• 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
• 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
• 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
• 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
• A slightly lower age has been recently
  reported from the northern part of the
• When all dermatoses in the elderly were
  considered, skin cancers ranked the least
  common .
Geographical environment.

Genetic attributes .

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
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

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
       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
• 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%)
Health authorities may consider
    1. Cancer Registry
    2. Public education
    3. Surgical Courses

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