Research Article, Clin Dermatol Res J Vol: 4 Issue: 1

Epidemiological Trends in Skin Cancer among Patients at King Abdul-Aziz University Hospital in Jeddah: A Follow-Up Study

Mawaddah Tallab^1,2*, Sultan Alfaer^1,3, Mohammed Abduljabbar¹ and Jehad Hariri¹

¹King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia

²King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

³King Fahad General Hospital, Jeddah, Saudi Arabia

*Corresponding Author : Mawaddah Abdulgader M Tallab
Department of Dermatology, King Fahad Armed Forces Hospital, Jeddah 21534, Saudi Arabia
Tel: +966 54 031 6333
E-mail: Mawaddah.tallab@hotmail.com

Received: September 17, 2018 Accepted: February 22, 2019 Published: March 04, 2019

Citation: Tallab M, Alfaer S, Abduljabbar M, Hariri J (2019) Epidemiological Trends in Skin Cancer among Patients at King Abdul-Aziz University Hospital in Jeddah: A Follow-Up Study. Clin Dermatol Res J 4:1. doi: 10.4172/2576-1439.1000129

Abstract

Keywords: Skin cancer, Epidemiology, Carcinoma

Introduction

Skin cancer incidence varies significantly worldwide, by geographical region, race, age, and social and environmental factors. According to incidence reports from the Saudi Cancer Registry in 2010, 12,909 adult cancer cases were detected in the kingdom’s 13 administrative regions. Skin cancer was the ninth most common cancer for males and females, representing 3.4% of all cases. Overall, skin cancer was slightly more common in males (53%). Basal cell carcinoma (BCC) was the most frequent type (45%). In order, the six regions with the highest skin cancer rates were Riyadh, Tabuk, Jazan, Eastern province, and the Northern and Qassim regions.

Recent studies indicate that over the past three decades, the frequency of skin cancer has exceeded that of prostatic and breast cancer and is significantly higher than the 31-year prevalence of all other cancers combined. While many studies have shown that the prevalence is increasing, studies regarding the burden and incidence of skin cancer are still lacking [1,2].

Several studies have investigated the trends of skin cancer incidence and patterns in different areas in Saudi Arabia. Our aim was to study current epidemiological trends in the incidence of malignant skin tumors. We conducted a retrospective study of patients at King Abdul-Aziz University Hospital (KAUH) and compared with previously published data at the same hospital during different time periods. In addition, we aimed to determine patterns of skin cancer incidence based on gender, age of occurrence, and anatomical site.

Methods

Study design and data collection

We retrospectively reviewed all histologically diagnosed cases of major skin cancer types during the six-year period from January 2011-December 2016. Patients’ demographic data like age, nationality, and gender were collected from medical records at KAUH in Jeddah, Saudi Arabia. We examined trends in the incidence, type of skin cancer, and anatomic sites.

Data analysis

Descriptive statistics were compiled into frequency tables. Categorical variables were compared between groups using chi-square tests, while chi-square or Fisher’s exact tests were used to determine significant relationships between variables. Analyses were performed using the Statistical Package for Social Sciences (SPSS, version 9).

Results

Fifty-one patients were diagnosed with skin cancer at KAUH from January 2011-December 2016, and their diagnoses of malignancy were confirmed histologically. Among these patients, 21 were Saudis and 30 were non-Saudis.

Although malignant melanoma (MM) occurred equally in males and females, the overall male-to-female ratio of all skin cancers was 2:1. BCC was the most prevalent type (64.7%), followed by squamous cell carcinoma (SCC; 31.4%) and MM (3.9%). As shown in Table 1, the mean age at diagnosis among all types was 55.2 years, while MM tended to occur at younger ages (mean, 41.5 years).

Table 1: Distribution of major types of skin cancer with mean age and male to female ratio.

Additionally, In spite of the fact that skin cancer occurred more frequently among elderly males, in younger age groups the incidence was higher among females than males. In contrast, the incidence for older patients was higher among males (≥ 60 years old; Table 2).

Table 2: Age and sex distribution of major types of skin cancer.

Analysis revealed that the predominant location for all types was the head and neck (78.3%), while less frequent locations were, in order, the trunk, upper and lower limbs, and genital areas. The one genital area case was SCC, while no melanomas were documented in areas other than the head and neck (Table 3).

Table 3: Site distribution of major skin cancer types.

Discussion

Skin cancer is an abnormal cell growth [3]. Although light-skinned individuals have a higher risk, skin cancer occurs in people of all colors and races, and its prevalence increases with age [4,5]. Non-melanoma skin cancers (NMSCs), including BCC and SCC, are the most common skin cancer types [6]. There has been a noteworthy worldwide increase in melanoma and NMSC prevalence in recent decades. Internationally, the highest reported skin cancer incidence rates are in New Zealand, followed by Australia, the United States, and Europe. Although melanoma is rare, there is a clear increase in the rate of melanoma diagnoses each year [7].

According to previous research, Saudi Arabia has low skin cancer incidence compared to other countries. Several attempts have been made to study the skin cancer prevalence in Saudi Arabia. Evaluating and understanding current epidemiological trends is necessary to successfully reach early and appropriate control of the disease.

KAUH is among the largest and the most frequently visited hospitals in Jeddah. Our analysis revealed 51 skin cancer cases from January 2011-December 2016, of which 33 were BCC (64.7%), with the head and neck being the most common sites (52.9%). There were 16 diagnoses of SCC (31.4%) and only a few melanomas (3.9%).

Many studies of skin cancer prevalence and patterns in KAUH have been performed. An earlier 10-year study (Jan 2000-Dec 2010) found 106 skin cancer cases, with similar patterns as our results: BCC (28.3%) and SCC (24.5%), were the most common, while 10.3% of cases were MM. The head and neck were the most common locations [8]. Moreover, an earlier study at KAUH (1984-1996) and King Khalid National Guard Hospital (1992-1996) reported 40 skin cancer cases at KAUH. The most common cutaneous malignancies were BCC (35%), SCC (20%), and MM (10.6%). Most BCCs occurred in the head region (84.6%) [9]. Consistently, we found that BCC remains the most prevalent type at KAUH, occurring most commonly in the head and neck. The MM rate was reduced while that of BCC was increased. However, differences in previous studies’ durations might have affected the number of reported cases when we evaluated annual skin cancer prevalence (Table 4). Although skin cancer presents more frequently among elderly males, in the occasional cases in early age it exhibits a unique pattern of higher frequency among females.

Table 4: Epidemiological trends of skin cancer at KAUH.

Our median patient age was 55.2 years. Consistent with previous studies at KAUH, MM occurred mainly in the extremities. Here, we noticed fewer MM cases, only in the head and neck, with equal numbers of females and males, and with a mean age younger than for other cutaneous malignancies (41.5 years). However, we must consider our study’s short duration of and that there were only two reported MM cases (Table 5).

Table 5: Malignant melanoma pattern.

Other regions of Saudi Arabia have reported similar patterns of skin cancer as our center. A 20-year epidemiological retrospective study in a tertiary center in Al-Dhahran (Johns Hopkins Aramco Healthcare) from 1995-2014 identified 204 cases; in descending order, the most common were BCC (36%) and SCC (23%), with the head and neck being the most common location for both types [10]. Furthermore, studies in Yemen and Bahrain have revealed the same pattern [11].

Conclusion

Our results demonstrate a stable trend of skin cancer types and anatomical sites throughout the years: BCC continues to be the most prevalent type, most commonly detected in males and at an old age. Regarding their distribution, skin lesions are located mainly in the head and neck. Cases at earlier ages (<60 years) showed a different trend, appearing more commonly among females. We noted an increase of BCC cases and a minimal reduction in the prevalence of MM compared to previous results from KAUH. However, our frequency estimates were based on histologically diagnosed skin cancer during a more limited period (6 years) than other studies. Our study has certain limitations, as we did not assess prognostic and risk factors such as skin color, UV exposure, sunscreen use, immunosuppressive treatments, chemical and viral carcinogens, radiation, phototherapy, or other associated comorbidities. We recommend further studies to evaluate metastatic sites and the epidemiology of secondary skin cancers.

Declarations

Ethics approval and consent to participate

The study protocol was reviewed and approved by the King Abdulaziz University Hospital Research Ethics Committee. Data was kept confidential and all patients were de-identified.

Availability of data and material

The data are not available for public access because of patient privacy concerns, but are available from the corresponding author on reasonable request.

Acknowledgement

We would like to acknowledge pathology department at king Abdulaziz University hospital for providing the data.

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