An Analysis of Biopsies for Suspected Skin Cancer at a Tertiary Care Dermatology Clinic in the Western Cape Province of South Africa

Abstract

Background. Skin cancer is a growing health concern worldwide. It is the most common malignancy in South Africa and places a large burden on the public healthcare sector. There is a paucity of published scientific data on skin cancer in South Africa. Objectives. To report the findings of biopsies performed in patients with suspected skin cancer attending the Tygerberg Academic Hospital (TAH) Dermatology outpatient department (OPD) in the Western Cape Province of South Africa. Methodology: A retrospective chart review identified all patients who underwent a biopsy for a suspected skin cancer diagnosis between September 2015 and August 2016 at the TAH dermatology OPD. Results. A total number of 696 biopsies from 390 participants were identified, of which 460 were histologically confirmed as malignant lesions. The proportion of clinically suspected skin cancers that were histologically confirmed as cancer was 68%. The most commonly occurring malignancies were basal cell carcinoma (BCC) (54.8%), squamous cell carcinoma (SCC) (18.9%), squamous cell carcinoma in-situ (SCCI) (8.0%), Kaposi’s sarcoma (KS) (6.7%), malignant melanoma (MM) (6.1%), and keratoacanthoma (KA) (4.6%). The number needed to treat (NTT) for all cancers diagnosed and for MM was 1.5 and 4 respectively. BCC (89.3%) and KS (67.7%) was the most common skin cancer in the white and black population respectively. The ratio of BCC to SCC was 2.03. Conclusion. This study provides valuable scientific data on the accuracy of skin cancer diagnosis, distribution and patient demographics in the Western Cape Province of South Africa, on which further research can be based. The study highlights the burden of skin cancer on this specific population group and calls for standardised reporting methods and increased surveillance of skin cancers.

A Profile and Three-Year Follow-Up of Patients with Basal Cell Carcinoma in the Western Cape, South Africa

“…During the study period, 696 biopsies from 390 patients were performed on clinically suspected skin cancer [ 11 ]. We included patients older than 18 years with histologically confirmed BCC.…”

“…Demographic data were obtained as secondary data from a previous study (HREC/REF: U16/10/028) [ 11 ]. Data about relevant medical history, previous treatments for BCC, tumour diameter and location, the procedure performed, and any BCC recurrence were retrieved for each case from records on the TAH Enterprise Content Management (ECM) system.…”

“…Therefore, we used the population group as a crude indication of phototype ∗ . A hot-deck imputation method was used when the population group was not indicated [ 11 , 13 ]. Patients were recorded as immunosuppressed if they had HIV, had a current malignancy (excluding KC), had a solid organ transplant, or used immunosuppressive medication.…”

Solar Ultraviolet Radiation, Skin Cancer and Photoprotective Strategies in South Africa†

“…One recent study illustrates typical findings relating to KCs in South Africa. Histological examination of 700 biopsies from patients with suspected skin cancer attending a dermatology clinic in the public health-care system in Western Cape Province found that 68% were malignant with 55% of these diagnosed as BCC and 19% as SCC (22). The face was the commonest location biopsied, followed by the leg.…”