Cutaneous malignancies in Indigenous Peoples of urban Sydney

Abstract

Introduction: Despite 3% of Australians identifying as Indigenous, cutaneous malignancies in these patients, including incidence, risk factors and outcomes have not been investigated. This is despite recognition that cancer outcomes in this population are significantly poorer. Methods: We undertook a retrospective case series of Indigenous Peoples who presented to two urban cancer therapy centres for the management of cutaneous malignancies from 2003 to 2017. Risk factors, tumour-specific characteristics, treatments and outcomes were reviewed. Results: Twenty-two patients identified as Aboriginal and/or Torres Strait Islander. The median age at presentation was 61 years and the majority were male (63.6%) and had skin phototype III (86.4%). Patients presented with basal cell carcinoma (50%), squamous cell carcinoma (31.8%), melanoma (9.1%) and cutaneous sarcomas (9.1%). The majority (68.2%) presented with stage II or higher disease, and there were high rates of immunosuppression (45.5%). At the time of reporting, 68.2% patients were alive, 18.2% had died from their skin cancers and 13.6% had died from unrelated causes. Conclusion: This cohort has demonstrated late-stage presentation of skin cancers, with substantial morbidity and mortality from potentially treatable cutaneous malignancies. This parallels other health conditions in Indigenous Australians and has highlighted the need for improved data collection of Indigenous status to better quantify the epidemiology of skin cancer in this population. There is an imperative to improve skin cancer awareness in this population to allow earlier detection and management to ensure better outcomes.

A casemix study of patients seen within an urban Aboriginal Health Service dermatology clinic over a five‐year period

“…In a previous study, risk factors for cutaneous malignancy within an urban Aboriginal and Torres Strait Islander cohort in Sydney were identified as male sex, skin phototype III and immunosuppression. 5 In that study, basal cell carcinoma was most common (50%), followed by squamous cell carcinoma (31.8%), melanoma (9.1%) and cutaneous sarcomas (9.1%). All malignant skin neoplasms except for the melanoma in situ occurred in Aboriginal and Torres Strait Islander patients, highlighting skin phenotype variability within urban Indigenous populations.…”

“…One 0.44 mm Breslow thickness invasive melanoma and one melanoma in situ were detected, both in male patients. In a previous study, risk factors for cutaneous malignancy within an urban Aboriginal and Torres Strait Islander cohort in Sydney were identified as male sex, skin phototype III and immunosuppression 5 . In that study, basal cell carcinoma was most common (50%), followed by squamous cell carcinoma (31.8%), melanoma (9.1%) and cutaneous sarcomas (9.1%).…”

Describing skin health and disease in urban-living Aboriginal children: co-design, development and feasibility testing of the Koolungar Moorditj Healthy Skin pilot project

“…Using the FSP classification, which is the most commonly used strategy to assess skin sensitivity to ultraviolet radiation despite inconsistencies being described in the skin of colour, we identified urban-living Aboriginal children with FSP II and III to be a subgroup with the most frequent sunburns where targeted sun protection messaging may be helpful [33,34,[66][67][68][69][70][71]. This is further supported by research showing urban-living Indigenous adults with FSP II and III are at the highest risk of developing skin cancer, representing 19 of the 22 (86%) Indigenous patients diagnosed with skin cancer between 2003 and 2017 in Sydney, Australia [72].…”