• Users Online: 228
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 27  |  Issue : 1  |  Page : 19-22

Epidemiological and localization characteristics of non-melanoma skin cancers: Retrospective analysis of 400 cases


1 Department of Pathology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
2 Department of Plastic Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
3 Department of Family Medicine, Konya, Turkey

Date of Web Publication4-Jan-2019

Correspondence Address:
Dr. Zeynep Altuntas
Department of Plastic and Reconstructive and Aesthetic Surgery, School of the Medicine, Necmettin Erbakan University, 42080 Meram, Konya
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_45_18

Get Permissions

  Abstract 


Aim: In this study, it was aimed to investigate the epidemiological and localization characteristics of the patients diagnosed with nonmelanocytic skin cancer (NMSC). Materials and Methods: Histopathologic results of patients diagnosed with NMSC in the Pathology Department of Necmettin Erbakan University, Meram School of Medicine, between 2007 and 2017 were retrospectively reviewed. The age, sex, tumor type, and localization of the patients were investigated. Results: A totals of 400 patients diagnosed with NMSC were identified. 220 of the patients were male (55%) and 180 were female (45%). The male to female ratio was 220/180 (1.22). The age range was 10–105-year-old and the mean age was 67.8. Basal cell carcinoma (BCC) was found in 263 patients (65%), squamous cell carcinoma (SCC) in 114 patients (28%) and baso SCC (BSCC) in 12 patients (3%). BCC and SCC were observed together in 9 patients. BCC was most commonly detected in the nasal region with (31%) 82 patients (50%). SHC was most commonly detected in the lower lip region with 26 patients (22%). The localization of the BSCC was most common in the nasal region with 6 patients (%50). The rate of BCC/SCC in the nasal region was 82/11. The BCC/SCC ratio in the extremity region was 4/14. Conclusion: In our region, the most frequent histopathologic diagnosis was found BCC in patients prediagnosed with NMSC, and most cases were seen in male patients. In cases of BCC a BSCC, the most common tumor localization was nose area while it was lower lip area in SCC cases. In addition, BCC and BSCC were not detected in the lower lip.

Keywords: Epidemiology, localization, nonmelanoma skin cancers, skin


How to cite this article:
Findik S, Uyanik O, Altuntas M, Altuntas Z. Epidemiological and localization characteristics of non-melanoma skin cancers: Retrospective analysis of 400 cases. Turk J Plast Surg 2019;27:19-22

How to cite this URL:
Findik S, Uyanik O, Altuntas M, Altuntas Z. Epidemiological and localization characteristics of non-melanoma skin cancers: Retrospective analysis of 400 cases. Turk J Plast Surg [serial online] 2019 [cited 2019 Apr 20];27:19-22. Available from: http://www.turkjplastsurg.org/text.asp?2019/27/1/19/249399




  Introduction Top


Nonmelanoma skin cancer (NMSC) is the most common type of cancer in Turkey, and its incidence is rising across the world. Whereas NMSC is four times more common than all other cancers combined, its nonaggressive progression, low risk of metastasis, nonlife-threatening behavior, and multi-factor pathophysiologic characteristics discriminate NMSC from melanoma and other cancers of the internal organs.

1.3 million new cases of NMSC are estimated to occur globally each year. The prevalence of NMSC among Caucasians in the US is reported to be 232 in 100,000. It is more commonly seen in Caucasian populations, especially in regions such as Australia, Central America, and Asia where exposure to sunlight is high. In the USA lifetime, risk of basal cell carcinoma (BCC) is reported 33%–39% among men and 23%–28% among women.[1],[2]

The types of NMSC are BCC, squamous cell carcinoma (SCC), and baso SCC (BSCC). A second incidence of nonmelanocytic skin cancer may occur within 2 years in 40% of the cases.

The incidence of BCC, the most commonly diagnosed skin tumor, has been rapidly increasing in the recent years.[3] Whereas NMSC shows low mortality and metastasis rates, the local invasive behavior of the tumor and its predilection for recurrence after treatment lead to severe morbidity in patients. More than half of the cases are observed to develop between the ages of 50 and 80 years, and its incidence increases with age.[4] BCC typically presents in white-skinned people in sites exposed to the sun (especially in the head and neck region). Despite being intensely exposed to sunlight, BCC is rare in the hands and the dorsal forearms.[5]

SCC occurs due to the malignant transformation of the epidermal keratinocytes. The rate of SCC incidences is reported 41 in 100,000 in the USA. Although ultraviolet radiation is mostly found epidemiologically responsible for its occurrence, age, skin type, and ethnicity are also reported to be effective. The increase seen in the prevalence of SCC in the last two decades, along with other types of skin cancers, is attributed to increasingly high exposure to sunlight, early diagnosis, and lengthening of human lifetime. Chronic inflammation, chronic wounds, and scars are blamed for the etiology of SCCs that occur in parts that are not exposed to sunlight. While acute and intense exposure to sunlight has a role in the etiology of BCCs, the etiology of SCCs is attributed to long-term chronic exposure.[6],[7]

BSCC was first described by MacCormac in 1910.[8] The tumor is thought to originate from the totipotent cells in the basal layer; however, there is insufficient information about BSCC as a result of the low number of cases. Ultraviolet radiation, advanced age, and smoking have a role in its etiology. Histologically, BSCC shows basaloid and squamous differentiation and presents clinical characteristics such as local recurrence and metastasis comparable to SCC. Ber-EP4 staining is useful in discriminating between BCC and BSCC.[9],[10]


  Materials and Methods Top


In this study, we retrospectively reviewed the histopathological diagnoses of patients who presented to our clinic with skin tumor in the years 2007–2017. Patients who were histopathologically diagnosed with NMSC (BCC, SCC, BSCC) were included in the study. Data on patient age, gender, tumor type, and tumor localization were analyzed. Distribution of tumor types by age and gender was identified. Patients who were diagnosed with pathologies in two or more regions in the same procedure were not included in the study. Consent was obtained from all patients before the study as required by the World Medical Association Declaration of Helsinki, and approval was obtained from the ethics committee for medical studies on humans.


  Results Top


A total of 400 patients were identified to be diagnosed with NMSC. Of these, 220 were male (55%) and 180 were female (45%). Male to female ratio was 1.22/1. The age range was 10–105 with a mean of 67.8 years [Figure 1] and [Figure 2]. 271 patients were diagnosed with BCC (67.7%), 117 patients were diagnosed with SCC (29.2 %) and 12 patients with BSCC. BCC was found to be most commonly localized to the nose region (82 patients, 31%), and least commonly to the extremities (4 patients, 1.5%). SCC was most commonly localized to the lower lip region (26 patients, 22%). No BCC and BSCC cases were identified in the lower lip region. Of the 12 patients diagnosed with only BSCC, 6 were female and 6 were male. The tumor was localized to the nose region in 6 patients (50%). There were no diagnoses of BSCC in the malar, lower lip, and scalp regions. In 9 patients, pathology results showed BCC and SCC in lesions at two different sites. Of these 9 patients, 3 were female and 6 were male. Two patients – 1 female and 1 male – had both SCC and BCC in different lesions. Of the total BCC and SCC cases, 82 and 111, respectively, were localized to the nose region. Of the patients diagnosed with BCC in the ear, 28 were male and 3 were female. In 4 BCC and 14 SCC cases, the tumor was localized to the extremities [Table 1].
Figure 1: Distribution of basal cell carcinomas by age and gender

Click here to view
Figure 2: Distribution of squamous cell carcinomas by age and gender

Click here to view
Table 1: Distribution of tumors by localization and patient age

Click here to view



  Discussion Top


The incidence of and morbidity and mortality from NMSC are increasing in many countries across the world. In the USA alone, 5.4 million cases of keratinocyte cancer (KC, also known as basal or SCC) are reported in about three million people. Based on the current data and with >1 million new cases in the same year, 1 in 5 people in the USA are estimated to be affected by a type of skin cancer in their lifetime. The economic magnitude of this public health issue is demonstrated in the costs associated with the treatment of skin cancers: The annual cost of treatment is reported to be >$500 million in the USA.[11] Given the small number of studies conducted on NMSC in Turkey, the available data is found insufficient for a statistical evaluation.

The skin is the organ most exposed to environmental ultraviolet radiation. Exposure of the skin to UV radiation can lead to demonstrable mutagenic effects. The p53 tumor suppressor gene, which is frequently mutated in skin cancers, is believed to be an early target of the neoplasms induced by UV radiation.[12]

The average amount of UV radiation per year is correlated with the incidence of skin cancers. A direct relationship is reported between the incidence of nonmelanoma skin cancers and the geographic latitude; in other words, a correlation has been shown to exist between increased exposure to UV radiation in regions closer to the Equator and the incidences of BCC and SCC.[13]

While the incidence of BCC in the USA is reported to have doubled in the last two decades,[14] the highest BCC rates in the world are reported in Australia.[15] BCC is the most common type of skin cancer and affects men about 1.5–2 times more than women.[16] In our study, 263 of the 400 patients were diagnosed with BCC, and the BCC to SCC ratio was 1:2.30. Among those diagnosed with BCC, the number of male patients were relatively higher (by 1.08%) than that of female patients; interestingly however, female patients constituted the majority in the 60–80 years of age group, and the number of male patients was twice that of female patients in the 80+ years of age group.

In 2012, the number of new SCC cases in the Caucasian populations in the USA was estimated between 186,000 and 419,000. In Australia, which has one of the highest SCC rates in the world, new SCC cases are reported in 1035/100,000 men and 472/100,000 women. In the USA, SCC cases under the age of 45 are reported to be three times more in men than women.[17] In our study, of the total 114 SCC cases, 70 were men and 44 were women, i.e., SCC was identified 1.5 times more in men than women. Although SCC diagnosis is rare under the age of 45 years, its incidence in young populations appears to be increasing in the recent years.[18] In our study, 7 of the SCC patients were under the age of 40.

The anatomic sites where skin cancers develop are observed to be associated with the average amount of UV radiation the site receives. Skin cancer is more commonly seen in regions, such as the head and the neck, that are almost constantly exposed to sunlight. Skin cancer incidence is low at sites rarely exposed to UV radiation, such as the scalp in women and the hips in both women and men.[19]

Regarding the location, in our BCC cases, the tumor was found to be most commonly localized to the nose region (82 patients, 31%). This is found consistent with those reported in the literature.

In SCC cases, the tumor was most commonly localized to the lower lip, the eye region, and the extremities, respectively. In the literature, SCC lesions in the extremities are more commonly reported in women than men.[20] In our study, the women to men ratio among those diagnosed with SCC in an extremity was found 9/5, and consistent with the literature. SCC is the most common type of nonmelanoma skin cancer diagnosed in the extremities. In our study, 14 patients (12%) were diagnosed with SCC and 4 patients (1.5%) with BCC localized to the extremity.

Since BSCC is a rare type of nonmelanoma skin cancer, there is insufficient data available in the literature. BSCC diagnoses are seen to be more frequent in men than women, and most common in the head and neck region, and the nose region.[21] In our case series, there were 14 BSCC cases, of which 7 are men and 7 are women. Among the 14 cases, 1 male and 1 female patient was concomitantly diagnosed with SCC at a different site. BSCC was most commonly localized to the nose region (6 patients, 50%).


  Conclusion Top


Among the patients that were prediagnosed with NMSC in our geographical region, BCC was the most common type that was histopathologically confirmed, and this type of tumor was mostly identified in male patients. Regarding location, the tumor was most commonly identified in the nose region in BCC and BSCC cases, and in the lower lip region in SCC cases. No BCC or BSCC cases were identified in the lower lip region. Distribution of the NMSC cases diagnosed in our geographical region is found consistent with those reported in the literature. The Konya region of Turkey, where this study was conducted, is an agricultural region and a significant portion of the population are agricultural workers, hence highly exposed to sunlight. Therefore, awareness should be raised among the public about simple everyday measures – such as wearing sunblock, hat and gloves – to protect from the effects of UV radiation, especially to the head and neck region, and the hands. This, we believe, will largely contribute to reducing the incidence of skin cancers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fahradyan A, Howell AC, Wolfswinkel EM, Tsuha M, Sheth P, Wong AK, et al. Updates on the management of non-melanoma skin cancer (NMSC). Healthcare (Basel) 2017;5. pii: E82.  Back to cited text no. 1
    
2.
Lear W, Dahlke E, Murray CA. Basal cell carcinoma: Review of epidemiology, pathogenesis, and associated risk factors. J Cutan Med Surg 2007;11:19-30.  Back to cited text no. 2
    
3.
Maia M, Proença NG, de Moraes JC. Risk factors for basal cell carcinoma: A case-control study. Rev Saude Publica 1995;29:27-37.  Back to cited text no. 3
    
4.
Mora RG, Burris R. Cancer of the skin in blacks: A review of 128 patients with basal-cell carcinoma. Cancer 1981;47:1436-8.  Back to cited text no. 4
    
5.
Leffel DJ, Brash DE. Sunlight and skin cancer. Sci Am 1996;275:56-9.  Back to cited text no. 5
    
6.
Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol 2012;166:1069-80.  Back to cited text no. 6
    
7.
Barton V, Armeson K, Hampras S, Ferris LK, Visvanathan K, Rollison D, et al. Nonmelanoma skin cancer and risk of all-cause and cancer-related mortality: A systematic review. Arch Dermatol Res 2017;309:243-51.  Back to cited text no. 7
    
8.
MacCormac H. The relation of rodent ulcer to squamous cell carcinoma of the skin. Arch Middx Hosp 1910;19:172-83.  Back to cited text no. 8
    
9.
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basosquamous carcinoma: Treatment with mohs micrographic surgery. Cancer 2005;104:170-5.  Back to cited text no. 9
    
10.
Maloney ML. What is basosquamous carcinoma? Dermatol Surg 2000;26:505-6.  Back to cited text no. 10
    
11.
Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (Keratinocyte carcinomas) in the U.S. Population, 2012. JAMA Dermatol 2015;151:1081-6.  Back to cited text no. 11
    
12.
Ouhtit A, Nakazawa H, Armstrong BK, Kricker A, Tan E, Yamasaki H, et al. UV-radiation-specific p53 mutation frequency in normal skin as a predictor of risk of basal cell carcinoma. J Natl Cancer Inst 1998;90:523-31.  Back to cited text no. 12
    
13.
Rigel DS. Cutaneous ultraviolet exposure and relationship to the development of skin cancer. J Am Acad Dermatol 2008;58:129-32.  Back to cited text no. 13
    
14.
Lazovich D, Choi K, Vogel RI. Time to get serious about skin cancer prevention. Cancer Epidemiol Biomarkers Prev 2012;21:1893-901.  Back to cited text no. 14
    
15.
Sinclair C, Foley P. Skin cancer prevention in Australia. Br J Dermatol 2009;161 Suppl 3:116-23.  Back to cited text no. 15
    
16.
Hoban PR, Ramachandran S, Strange RC. Environment, phenotype and genetics: Risk factors associated with BCC of the skin. Expert Rev Anticancer Ther 2002;2:570-9.  Back to cited text no. 16
    
17.
Leiter U, Garbe C. Epidemiology of melanoma and nonmelanoma skin cancer – The role of sunlight. Adv Exp Med Biol 2008;624:89-103.  Back to cited text no. 17
    
18.
Christenson LJ, Borrowman TA, Vachon CM, Tollefson MM, Otley CC, Weaver AL, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005;294:681-90.  Back to cited text no. 18
    
19.
Cress RD, Holly EA, Ahn DK, LeBoit PE, Sagebiel RW. Cutaneous melanoma in women: Anatomic distribution in relation to sun exposure and phenotype. Cancer Epidemiol Biomarkers Prev 1995;4:831-6.  Back to cited text no. 19
    
20.
Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. Eur J Cancer 2012;48:2046-53.  Back to cited text no. 20
    
21.
Garcia C, Poletti E, Crowson AN. Basosquamous carcinoma. J Am Acad Dermatol 2009;60:137-43.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed367    
    Printed102    
    Emailed0    
    PDF Downloaded89    
    Comments [Add]    

Recommend this journal