Pattern of Skin Cancers in a Tertiary Medical Center in Southwest Nigeria

Adedayo Idris Salawu1,2, Olakunle Fatai Babalola1,2, Oladipo Omoseebi3,4, Olagoke Erinomo3,4, Tope Michael Ipinnimo5, Shiyanbola Akinlolu Christopher6,7,Adeniyi Steven Hassan1

1Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Nigeria and

2Department of Surgery, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria.

3Department of Anatomic Pathology, Federal Teaching Hospital, Ido-Ekiti, Nigeria and

4Department of Anatomic Pathology, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria.

5Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria.

6Department of Medicine (Dermatology Unit), Federal Teaching Hospital, Ido-Ekiti, Nigeria and

7Department of Medicine, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria.

 

Correspondence to: Dr. Adedayo Idris Salawu; email: dayosalawu@gmail.com

Received: 2 Jul 2021; Revised: 28 Dec 2021; Accepted: 23 Jan 2022; Available online: 25 Mar 2022

Abstract

Background: Skin cancers are the most common malignancies in the western world, and their incidence is increasing globally. However, the data about the pattern in sub-Saharan Africa are limited. This study evaluates the pattern of primary skin malignancies in a tertiary medical center located in a sub-urban area. Methods: The histo-pathological records of patients managed for malignancies from January 2012 to December 2020 were retrieved from the pathology department of a tertiary medical center in Ekiti State, Southwest Nigeria. All primary skin cancers seen within this study period were extracted from the records and then reviewed retrospectively. Results: The male-to-female ratio of primary skin malignancies was 1:1.06, and the mean age of patients was 57.2 ± 17years. All patients were black Africans who were mainly of the Yoruba ethnicity (97.2%). Squamous cell cancer had the highest frequency (34.7%), followed by melanoma (27.8%), dermatofibrosarcoma (12.5%), and basal cell carcinoma (11.1%). The most commonly affected anatomic region is the lower limbs (50.6%). Conclusion: The pattern of primary skin cancers seen in black Africans differ from that of Caucasians: however, larger community-based studies in our environment is recommended to provide more conclusive information about the pattern of skin cancers.  

 

Keywords: Primary skin cancers, Skin malignancies, Blacks

 

Ann Afr Surg. 2022; 19(2): 73-78

DOI: http://dx.doi.org/10.4314/aas.v19i2.3

 

Funding: None

 

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction 

Skin cancers constitute a significant source of morbidity and mortality worldwide(1). They have been reported to be the most common forms of malignancies in the European population, and the main etiological factor is ultraviolet radiation cutaneous injury (2). Skin cancers are less common in the black African population than in the Caucasian population due to the high melanin content of the negroid skin, which protects them from ultraviolet radiation(3,4). The reported incidence of skin cancer in Africa varies from center to center and this is on the rise(5). The postulated  reasons for this rise has been attributed to increasing exposure to ultraviolet radiation from depletion of the ozone layer, increased incidence of human immunodeficiency virus (HIV) infection and repetitive trauma and chronic irritation in scars(5). 

 

In terms of histological type, basal cell carcinoma has the highest incidence among the European population, followed by squamous cell carcinoma and other forms of skin cancers(3). Melanoma represents a smaller proportion of cases, and it occupies a special status when skin malignancies are being studied because it is responsible for a larger proportion of the mortality from skin cancers(2). In black African population, melanoma appears to be the most frequently occurring skin cancer, but melanoma incidence is much lower than that in white populations(2,3).

 

The differences in the pathological characteristics of melanoma and other skin cancers has led most authors to classify skin cancers as either non-melanoma skin cancers (NMSCs) or melanoma skin cancers (MSCs)(3). MSCs have a tendency to metastasize early, and they do not respond well to chemotherapy and radiotherapy; hence, the main stay treatment remains surgical excision. Meanwhile, NMSCs have a lesser propensity to metastasize, and they respond to surgery, chemotherapy and radiotherapy well, but they might cause significant morbidity as well as mortality when left untreated(6).

When the anatomical sites of the skin malignancies were studied; the head and neck region and other sun-exposed areas of the body were the most frequent site of occurrence in Caucasians, whereas the lower limbs were the common site in black Africans. This may be due to the ultraviolet radiation skin damage in Caucasians, whereas non-solar risk factor such as trauma is thought to be a cause in African blacks(3).

 

In studies done in Africa, in the findings on male-to-female ratio were not consistent (5,7,8,9). There is disparity in the epidemiological findings from