Skin Cancer in Western Saudi Arabia By Khalid M Al Aboud, MD Khalid M Al Aboud, MD Medical Director and Consultant Dermatologist,King Faisal Hospital,Makkah.

Introduction:  There are few reports that focused on skin cancers in KSA  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.

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.

Material and Methods:  Records of newly diagnosed cases of skin cancer for a period of 10 years spanning were obtained.  All the malignant skin lesions, either biopsied or excised, were included.

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.

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. M:F ratio of 2,25:1; non-Saudis were 1 male and 2 female.

TOTAL (%) > <40 AGE IN YEARS DIAGNOSIS 53 (50.96) BCC 27 (25.96) SCC 13 (12.50) MM 02 (1.92) Appendageal 04 (3.84)01 Miscellaneos 05 (4.82) Metastatic 104 (100) TOTAL

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.

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.

TOTAL (%) MALE:FEMAE RATIO MEDIAN AGE DIAGNOSIS 53 (50.96)2.5: 165BCC 27 (25.96)1.7: 161SCC 13 (12.50)3.3: 164MM 02 (1.92)1 : 145Appendageal 04 (3.84)3 :160Miscellaneous 05 (4.82) 2 :370Metastatic

TOTAL (%) OTHERS TRUNKLOWER LIMBS UPPER LIMBS HEAD AND NECK DX 53 (100) (3.77)01(1.88)03(5.66) 47(88.67) BCC 27 (100)04(14.81)02(7.4007(25.92)05(18.51)09(33.33) SCC 13 (100) (23.07)06(46.15)02(15.38) MM 02 (100) (100) App 04 (100) (50.00)01(25.00) (25.00) Misc

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.

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.

Continued… 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 years.

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.

Continued…  Geographical environment.  Genetic attributes.  Custom.

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.

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.

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 carcinoma.

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 cancers. 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 countries

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( ): 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%)

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