Primary cutaneous malignancies in the Northern Cape Province of South Africa: A retrospective histopathological review

Abstract

Background.Excessive sun exposure and a high prevalence of HIV increase skin cancer risk in South Africa (SA). Objective. To describe the nature and extent of skin cancers presenting in the public and private health sectors of the Northern Cape Province of SA. Methods. A retrospective analysis of histologically confirmed new primary cutaneous malignancies from 1 January 2008 to 31 December 2012 was conducted using public and private health sector databases. Types, quantity and distribution of common invasive malignancies by population group, age, gender, anatomical site and health sector were explored. One-year cumulative incidence was calculated and logistic regression models were used to analyse incidence and melanoma thickness trends. Results. A total of 4 270 biopsies (13 cutaneous malignancies) were identified. The commonest was squamous cell carcinoma (SCC), followed by basal cell carcinoma, Kaposi's sarcoma (KS), cutaneous malignant melanoma (CMM) and basosquamous carcinoma, in descending order. The odds of a white male developing SCC increased by 8% each year (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01 -1.15; p=0.022), while the odds of a black male developing SCC and KS decreased by 9% (OR 0.91, 95% CI 0.84 -0.99; p=0.033) and 18% (OR 0.82, 95% CI 0.70 -0.97; p=0.022), respectively, each year. SCC and CMM were diagnosed at more advanced stages in the public than in the private healthcare sector. CMM is being detected earlier, as indicated by low-stage depth increasing by 72% annually (OR 1.72, 95% CI 1.04 -3.01; p=0.042). Conclusions. Results suggest that reported skin cancer patterns are changing. There is a need for further research and equitable appropriation of financial resources and effort towards developing primary skin cancer prevention initiatives in SA.

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

“…KS accounted for 7% of all skin cancers diagnosed and was the most frequent skin cancer in the black population. is finding supports data from the Northern Cape Province of South Africa that showed KS to account for 6.5% of all skin cancers and occurring more commonly in the black population [26]. When compared to data from sub-Saharan African, Nthumba et al reported KS to represent 25% of skin cancers diagnosed in Kenya in 2008 [24].…”

“…e largest review reported SCC and KS to constitute 44% and 25% respectively of the cutaneous malignancies and BCC's only 7% [24,25]. Interestingly a recent study done in the Northern Cape Province of South Africa also found that 45.4% of skin cancers diagnosed were SCC while only 27.8% were BCC [26]. ese differences in skin cancer frequency can most likely be attributed to the difference in population distribution in the Western Cape when compared to that of other sub-Saharan African countries and other parts of South Africa.…”

Clinical and pathological features of acral melanoma in a South African population: A retrospective study

“…[3,5,6] In a large German cohort (2 050 ALM patients) the mean Breslow thickness was 3.08 mm (median 2.2 mm), [5] which was in keeping with other studies on ALM from developed countries that reported a mean Breslow thickness between 2.51 mm and 2.8 mm at presentation. [6,15] York et al [19] reported a mean Breslow depth of 4.13 mm in ALMs diagnosed in the Northern Cape Province of SA. In the current study, mean Breslow thickness at diagnosis was 5.2 mm (median 4.2, range 0 -22), suggesting that patients present much later than the norm in developed countries.…”

The incidence of melanoma in South Africa: An exploratory analysis of National Cancer Registry data from 2005 to 2013 with a specific focus on melanoma in black Africans

“…Studies have focused on a single population group [5,6] or a single province. [5][6][7] Skin cancer incidence data were last reported for 2000 -2004 (inclusive), showing differences in incidence rates and body sites by population group and gender. [8] Melanoma is more common in fair than dark individuals, but does occur in black Africans.…”

“…[9][10][11][12] Several studies have reported worse disease outcomes for melanoma patients with darker skin types [10,12,13] and melanoma of hands and feet. [1,14] Objectives Variation in reported SA incidence rates of melanoma [5,[7][8][9] makes it difficult to form robust conclusions. Incidence rates ranging from 11.8 per 100 000 in white females in Northern Cape Province [7] to 69 per 100 000 for the white population in Western Cape Province have been reported.…”