Skin Cancer in Western Saudi Arabia

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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

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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.
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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.

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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.

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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.

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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.

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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.

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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)
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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.
  

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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.

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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)
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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)
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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.

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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.

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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.

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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
  .

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Continued

• Geographical environment.
• Genetic attributes .
• Custom.

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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.

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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.

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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.

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Study based Facts

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

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Study based Facts

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

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Study based Facts

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

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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 .

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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.

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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
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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
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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
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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
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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
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Optimal managment of Skin Cancer
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Public education
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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)

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