Site Distribution of Different Types of
MATERIALS AND METHODS
The present study was done in the department of pathology, S.S. institute of Medical Sciences and Research Centre, tertiary care hospital, Davangere which caters largely to the surrounding village population. A total of 40 cases with histological diagnosis of cutaneous malignancy i.e. malignant melanoma (MM), basal-cell carcinoma (BCC) and squamous-cell carcinoma (SCC) from January 2005 to December 2009 were analyzed. Malignancies of skin adenexa and anogenital region were excluded from the study. The variables evaluated included age, gender and site distribution of three main types of skin cancer the details of which were obtained from case records.
RESULTS
During the study period forty tissue samples received were histologically confirmed to be of common primary skin cancers. Table 1 shows the relative incidence of skin cancer types. Squamous cell carcinoma (SCC) was the most common malignancy consisting of 26 (65 %) cases followed by melanoma with 9 (22.5%) cases and basal cell carcinoma (BCC) with 5 (12.5%) cases. Age of patients ranged from 18 years to 80 years with mean age of 51.4years (Table 2).
29 cases (72.5%) were males and 11 cases (27.5%) females with a male to female ratio of 1: 0.37. The most common incidence was among the age group 40-60 years with 20(50%) cases detected. Tumors were rare below the age of 30 years with only 4 cases.
Table 3 shows the Age and sex distribution of skin cancer. High Incidence of malignant melanoma was
between 41-50 yrs, basal cell carcinoma 61-70 yrs and squamous cell carcinoma 51-60 yrs. Distribution of primary sites involved is shown in Table 4. Most cases of SCC (50%) were seen in the head and neck region with majority in face including lip. Equal number of SCC (38.4%) were also seen in lower limb especially involving the foot. Melanoma occurred more on the lower extremities (66.7%) frequently involving the foot.
Among the BCC, majority of the cases i.e. 80% were reported in the head and neck region with the predilection for face.
Table 1. Relative incidence of skin cancer.
Type Number Percentage
Squamous cell carcinoma 26 65.0
Malignant melanoma 09 22.5
Basal-cell carcinoma 05 12.5
Total 40 100
Table 2. Age/gender distribution.
Age range Gender Total (%)
M F
01-10 0 0 0 (0)
11-20 2 0 2 (5)
21-30 1 1 2 (5)
31-40 4 2 6 (15)
41-50 7 2 9 (22.5)
51-60 9 2 11 (27.5)
61-70 4 3 7 (17.5)
71-80 2 1 3 (7.5)
Total 29(72.5) 11(27.5) 40(100)
Mean: 51.4 years; age range: 18-80 years.
Table 3. Age/sex distribution of Skin cancer.
AGE MM BCC SCC Total
M F M F M F
01-10 0 0 0 0 0 0 0
10-20 1 0 0 0 1 0 2
21-30 0 0 0 0 1 1 2
31-40 0 1 0 0 4 1 6
41-50 3 1 0 0 4 1 9
51-60 1 1 1 0 7 1 11
61-70 0 0 2 2 2 1 7
71-80 1 0 0 0 1 1 3
Total 6 3 3 2 20 6 40
MM: Malignant ,melanoma, BCC: Basal cell carcinoma, SCC: Squamous cell carcinoma
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Table 4. Site distribution of different types of skin cancer
Site Distribution Number Total (%)
Malignant Basal-cell Squamous cell
Melanoma carcinoma carcinoma
Head & neck 1(11.1) 4(80) 13(50) 18(45)
Scalp - 1 3 4
Ear - - 1 1
Face 1 3 9 13
Upper limb& shoulder 2(22.2) - 2(7.7) 4(10)
Axilla 1 - - 1
Arm - - 2 2
Hands 1 - - 1
Lower limb 6(66.7) 1(20) 10(38.4)
17(42.5)
Thigh - - 2 2
Popliteal fossa 1 - 2 3
Leg - - 2 2
Foot 5 1 4 10
Unknown - - 1(3.9) 1
Total (%) 9(100) 5(100) 26(100) 40(100)
DISCUSSION
Squamous cell carcinoma, Basal cell carcinoma and malignant melanoma constitute three main histotypes of skin cancer4. Skin cancers occur mainly in the sixth, seventh and later decades12, 14-15.
In the present series, nearly 70% of all reported cases of cancer relate to the fifth and later decades.
The frequency of skin cancers in men and women is different. Present study shows male preponderance comparable to other studies13-15. Skin cancers occur mainly in the sun exposed regions predominantly involving face and neck areas of the body13,16. Present study also shows that 45% of the reported skin cancer types were found in the head and neck region which demonstrate the major influence of sun exposure in the development of skin cancers.
SCC was the commonest skin cancer in the present series similar to other studies11,13. SCC commonly occurs on sun damaged skin. Our results indicate that SCC compared to malignant melanoma affect body locations which are usually sun exposed, such as the face, scalp and upper arm. This corroborates previous studies by Franceschi et.al1 and the findings are in line with continuous chronic sun exposure playing a more important role for SCC than melanoma. Present study shows predominant clustering of SCC over fifth decade and later.
Melanoma ranked the second most frequent tumor after SCC. The site distribution of melanoma does not accord with sun exposure in comparison with the non- melanoma skin tumours10. Foot was the major site of
involvement in the present study thus indicating the role of non-solar risk factor similar to other studies.11 Melanoma showed clustering of cases over fourth decade.BCC was the third most common lesion in the present study contrast to other studies14,15. BCC in this series predominantly involved the face comparable to other studies9 and showed high incidence rate over sixth decade.
In conclusion Squamous cell carcinoma, Basal cell carcinoma and malignant melanoma constitute three most frequent primary skin cancers. SCC and BCC compared to malignant melanoma affect body locations which are usually sun exposed. Age-related behavior (i.e., another indirect indicator of duration of exposure to UV light) especially for nonmelanoma skin cancer is consistent with the anatomical distribution of skin cancer.
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