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Skin Cancer in Western Saudi Arabia

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Title: Retrospective study of skin cancers in Taif region, Saudi Arabia, in the last decade Author: ahmad Last modified by: / – PowerPoint PPT presentation

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Title: Skin Cancer in Western Saudi Arabia


1
Skin Cancer in Western Saudi Arabia
  • By
  • Khalid M Al Aboud, MD
  • Medical Director and Consultant
    Dermatologist,King Faisal Hospital,Makkah.
  • E-mail amoa65_at_hotmail.com

2
Contributers
1-Dr. Khalid Al Aboud
2-Dr. Khalid A Al Hawsawi
3-Dr. Manzoor A. Bhat
4-Dr. Venkatachari Ramesh
5-Dr. Syed Mubashir Ali
Department of Medicine (Dermatology and
Oncology Units), King Faisal Hospital, Taif,
Saudi Arabia.
3
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.

4
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.

5
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.

6
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.

7
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.
  • MF ratio of 2,251 non-Saudis were 1 male and 2
    female.

8
TOTAL () gt80 60-79 40-59 lt40 AGE IN YEARS DIAGNOSIS
53 (50.96) 11 19 17 06 BCC
27 (25.96) 06 12 06 03 SCC
13 (12.50) 01 07 04 01 MM
02 (1.92) --- 01 --- 01 Appendageal
04 (3.84) 01 01 01 01 Miscellaneos
05 (4.82) 01 03 01 --- Metastatic
104 (100) 20 43 29 12 TOTAL
Table(1)
9
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.

10
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.

11
TOTAL () MALEFEMAE RATIO MEDIAN AGE DIAGNOSIS
53 (50.96) 2.5 1 65 BCC
27 (25.96) 1.7 1 61 SCC
13 (12.50) 3.3 1 64 MM
02 (1.92) 1 1 45 Appendageal
04 (3.84) 3 1 60 Miscellaneous
05 (4.82) 2 3 70 Metastatic
Table(2)
12
TOTAL () OTHERS TRUNK LOWER LIMBS UPPER LIMBS HEAD AND NECK DX
53 (100) ----- 02(3.77) 01(1.88) 03(5.66) 47(88.67) BCC
27 (100) 04(14.81) 02(7.40 07(25.92) 05(18.51) 09(33.33) SCC
13 (100) ----- 03(23.07) 06(46.15) 02(15.38) 02(15.38) MM
02 (100) ----- ----- ----- ----- 02(100) App
04 (100) ----- 02(50.00) 01(25.00) ----- 01(25.00) Misc
Table(3)
13
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.

14
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.

15
Continued
  • Skin cancer ranks highest in the southern region
    of the kingdom with a MF ratio of 2.41 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.

16
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
    .

17
Continued
  • Geographical environment.
  • Genetic attributes .
  • Custom.

18
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.

19
Study based Facts
  • 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.

20
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.

21
Study based Facts
  • (3) MM
  • represented 12.50 of the cutaneous cancers in
    Taif region with a conspicuous MF ratio of
    3.31.

22
Study based Facts
  • (4) Appendageal Tumors
  • are common but usually benign.
  • Limited to head and neck area.

23
Study based Facts
  • (5) Miscellaneous Tumors
  • rare .
  • Tumors were seen include dermatofibrosarcoma
    protuberans, Kaposi's sarcoma and verrucous
    carcinoma.

24
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 .

25
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.

26
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.

Stirling et al., 1979
Khan et al., 1991
Central laboratory, Jeddah, KSA
Asir Central Hospital, Abha, KSA
27
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 .

Ajarim, 1992
Al Mobeerik, 1998
King Khalid University Hospital, Riyadh, KSA
Laboratory Department, Riyadh, KSA
28
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.

El Hag et al., 2002
Prince Abdul Rahman Al Sudairy Central
Hospital, Al Jouf, KSA
29
Skin Cancer in KSA
  • Reports that focused on skin cancer
  • 22 cases of MM, 54of them showed acral
    distribution. Tumors were on the foot or the
    head, advanced at diagnosisrapidly fatal.
  • 14 cases were reported of Kaposi sarcoma among
    263 renal transplant recipients with incidence of
    5.3compared with an incidence of 0.4in renal
    transplant recipients from western countries

MughalRobinson,1982
Quip et al,1988
King Faisal Hospital Research Center, Riyadh,
KSA
30
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
    BCCMM.
  • In retrospective study 2 cases of MM were
    founded in one decade.

BahamdanMorad,1993
Al-Shlash et al, 1998
Asir Central Hospital,Abha,KSA
North West Military Hospital,Tabuk,KSA
31
Optimal managment of Skin Cancer
32
Public education
33
National Cancer Registry
  • 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)

34
GOALS Health authorities may consider 1. Cancer
Registry 2. Public education 3. Surgical
Courses
35
Thank you
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