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Year : 2020  |  Volume : 24  |  Issue : 2  |  Page : 105-109

Pattern of skin cancer in Saudi patients at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia between 2005 and 2015: A retrospective study

1 Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center (KAIMRC), Riyadh, KSA
2 Department of Dermatology, Prince Sultan Military Medical City, Riyadh, KSA
3 Department of Dermatology, King Abdulaziz Medical City, Riyadh, KSA
4 King Abdullah International Medical Research Center (KAIMRC); Department of Basic Medical Sciences, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA

Date of Submission05-Jun-2020
Date of Acceptance01-Sep-2020
Date of Web Publication10-Nov-2020

Correspondence Address:
Dr. Sultan Al Qahtani
Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh; King Abdullah International Medical Research Center, Riyadh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdds.jdds_18_20

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Background: Skin cancer is one of the most common among white-skinned individuals. Its prevalence depends on geographic and ethnic variations. The pattern of skin cancer in Saudi patients per province is not well-established. Purpose: This retrospective study evaluated the pattern of skin cancer among Saudi patients from Riyadh area who have visited King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, between the years of 2005 and 2015. Methods: Data from 300 cancer patients were collected from KAMC and analyzed with respect to age, sex, cancer type, and cancer location. Results: Except for mycosis fungoides (MF), all other studied skin cancer types were more common in males as compared to females (1.56:1). Among the study population, the majority of skin cancer cases were seen in patient who aged more than 40 years old (86%) with the highest rate to be among those who are between 60 and 79 years old. Among all cases, the pattern and ratio of various skin cancers were as follows: Basal cell carcinoma (BCC) (45.7%), squamous cell carcinoma (SCC) (14.7%), MF (7.3%), and malignant melanoma (MM) (7%), followed by sebaceous adenocarcinoma (SC), Kaposi sarcoma, and dermatofibrosarcoma protuberance each of 4.3%. With respect to cancer location, 141 cases were located on the face (46.95%), 46 on the hips and lower limbs (15.26%), 44 on the chest and abdomen (14.8%), 28 on the scalp and neck (9.29%), 21 on the shoulders and upper limbs (6.95%), and 17 were unspecified. Conclusion: Among Saudi patients with skin cancer in the central region of the Kingdom of Saudi Arabia (KSA), BCC and SCC were the most common cancers, followed by MF and MM. Further studies are needed to fully determine common risk factors among these and future cases.

Keywords: Cancer, King Abdulaziz Medical City, Riyadh, Saudi Arabia, skin

How to cite this article:
Al Qahtani S, Aldahash R, BinManie N, Al Assiri M. Pattern of skin cancer in Saudi patients at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia between 2005 and 2015: A retrospective study. J Dermatol Dermatol Surg 2020;24:105-9

How to cite this URL:
Al Qahtani S, Aldahash R, BinManie N, Al Assiri M. Pattern of skin cancer in Saudi patients at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia between 2005 and 2015: A retrospective study. J Dermatol Dermatol Surg [serial online] 2020 [cited 2021 May 11];24:105-9. Available from: https://www.jddsjournal.org/text.asp?2020/24/2/105/300386

  Introduction Top

Skin cancer is one of the most common cancers among white-skinned individuals of both sexes worldwide.[1] Two types of skin cancer exist, malignant melanoma (MM), and nonmelanoma skin cancer including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).[2],[3] Exposure to ultraviolet (UV) radiation, age, sex (male), genetic susceptibility, and other nonmodifiable factors is risk factors for skin cancer.[4],[5],[6]

Skin cancer prevalence also depends on geographic and racial variations, with the highest rate occurring in Australia.[7] In the Kingdom of Saudi Arabia (KSA), skin cancer ranked 9th among cancer types in both males and females.[8] Over the last few decades, several studies were conducted in Saudi Arabia to determine the national prevalence of skin cancer in KSA. In the Al-Taif region, the prevalence of skin cancer was reported in individuals over the age of 60 (2.25:1 male:females) where the prevalence of BCC and SCC to be the most dominant (51% and 26%, respectively).[9] In the Al-Baha region (southwestern area of KSA), the average age of skin cancer patients was 70–80 years old (1.6:1 male: females) with BCC, SCC, and Kaposi sarcoma (KS) representing the most commonly observed types (41%, 29%, and 18%, respectively).[10] In Jeddah (the western region of the KSA), the average age of skin cancer patients was 46 years old (2.1:1 male:female) with BCC, mycosis fungoides (MF), MM, and dermatofibrosarcoma protuberance (DFSP) representing the most dominant types (28.3%, 24.5%, and 10.3%, respectively).[11] Similar results were also reported in the Al Qassim region (central area of KSA).[12] However, BCC and SCC were the most common skin cancer in the Dammam area with prevalence rates of 26% and 22.2%, respectively (eastern region of KSA).[13]

Riyadh, the capital of the KSA, has a very large mixed population of various nationalities (8,216,284 individuals in 2017). Centrally located in the KSA, the Riyadh region has a very hot climate year-round. However, the pattern of skin cancer in Riyadh is still not well-established. Therefore, we aimed to study the pattern of skin cancer among diagnosed Saudi patients who were born and lived most of their life in Riyadh area and visited King Abdulaziz Medical City (KAMC) between the years 2005 and 2015.

  Methods Top

This retrospective study was conducted between January 2005 and December 2015 based on data from various Saudi patients with skin cancer who visited KAMC. All data were collected from the patient database available at King Abdullah International Medical Research Center (KAIMRC), Riyadh, KSA which has a filing report and access to all these data. The Ethical Research Committee of KAIMRC approved this study (IRB number SP16/026). All patients' data, including the date of visit, biopsy receipt, age, sex, nationality, diagnosis, morphology, and topography, were provided by the authorized personnel on a computerized Excel sheet from KAMC records. A double manual check was performed to exclude duplicated patient data. Data were analyzed using (SPSS, version 20), IBM company, New York, USA, categorical data were presented as frequencies and percentages while numerical data were presented as a mean. Previously, it was shown that the prevalence of BCC in KSA to between 26% and 41%. With a 95% confidence level and margin of error of 5%, the required sample size was calculated using the Raosoft sample size website to be 306 skin cancer patients. All patients selected in this study were born and lived all their life in the Riyadh area.

  Results Top

This study included 300 patients; the majority of patients (84%) were older than 40 years old, with an average age of 59.8 years. The highest prevalence of skin cancer (40%) was seen among the 60–79 years of age group. This was followed by 29.3% in the 40–49 years of age group, 14.6% in the over 80 years of age group, 13% in the 20–30 years of age group, and 3% in the under 20 years of age group [Table 1]. Further analysis revealed 184 males and 116 females with confirmed skin cancer, representing 61.3% and 38.7% of total patients respectively, with a male: female ratio of 1.56:1 [Table 1].
Table 1: Mean age and number of males and females patients with confirmed skin cancer

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Among all examined skin cancers - excluding MF, which was more common in females - the prevalence of all other types of cancers was more common in males as compared to females (higher males to female ratios) [Table 2]. Further analysis of these data revealed that the most common type of skin cancer among those patients was BCC with a prevalence a percentage of 45.7%, followed by SCC (14.7%), MF (7.3%), MM (7%), sebaceous adenocarcinoma (SC; 4.3%), and DFSP (4.3%) [Table 2].
Table 2: Distribution of different skin cancers among all patients with respect to their mean age and sex ratio

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Topographic data for cancer location among tested patients are depicted in [Table 3]. The most prevalent location of skin cancer was on the face (46.95%), followed by the hips and lower limbs (15.26%), chest and abdomen (14.58%), scalp and neck (9.29%), and shoulders and upper limbs (6.95%) [Table 3]. Among 137 patients with BCC, 102 were affected on the face (74.4%), 11 on the chest and abdomen (8%), 10 on the scalp and neck (7.3%), 8 on the lower limbs (5.8%), and 2 on the upper limbs (1.5%) [Table 3]. Among 44 patients with SCC, 19 were affected on the face (43.2%), 7 on the upper limbs (15.9%), 6 on the scalp and neck (13.6%), and 11 on the trunk and the lower limbs (11.4%) [Table 3]. Among 22 cases of MF, 10 were located on the chest and abdomen (47.6%), 7 on the lower limbs (28.6%), and 3 on the upper limbs (14.3%). In 21 MM cases, 11 were located on the hind and lower limbs (52.4%), 3 on the scalp and neck (14.2%), and 3 on the chest and abdomen (14.3%) [Table 3]. Of 13 DFSP cases, 5 were located mainly on the chest and abdomen (38.5%), 2 on the scalp and neck (15.4%), 2 on the shoulders and upper limbs (15.4%), 2 on the hips and lower limbs (15.4%), and 1 on the face (7.6%). For the 13 patients with KS, one patient was affected on the trunk area (7%), 8 patients on the lower limbs (61%), and 4 patients with nonspecified locations (32%) [Table 3].
Table 3: The location of skin cancer types on the different part of the body of the affected people

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  Discussion Top

The major findings of this study clearly show that the majority of skin cancer cases among the Saudi patients who live in Riyadh area and previously visited KAMC were observed in those who aged more than 40 years old (86%), with the highest rate of affected individuals within the 60–79 years of age group (40%). The common observed types (pattern) among those patients were BCC (45.7%), SCC (14.7%), MF (7.3%), and MM (7%) SC (4.3%), KS (4.3%), and DFSP (4.3%). However, except for MF, all these cancer types occurred at a higher rate in males than females with a total ratio of 1.56:1 (male:female).

Globally, skin cancer is a major concern due to its high prevalence and increasing morbidity. Skin cancer predominantly affects white-skinned individuals with prevalence varying around the world. In the United States, skin cancer is the most common cancer, representing about 35%–45% of all neoplasm cases.[14] Australia has the highest rate of increase in skin cancer with a percentage of 1%–2% of all population/year.[15],[16],[17],[18] In Europe, Switzerland has the highest rate of skin cancer.[19] In the KSA, an approved cancer incidence report published in 2010 showed that skin cancer constitutes 4.1% of all neoplasm cases among the entire population.[20]

Among previous studies conducted throughout the KSA, this study was unique as it investigated Saudis in the central region, which lacks supporting studies. Besides, this study investigated a large number of patients (300), nearly as many as previous studies in the KSA.[9],[10],[11],[12],[13] Furthermore, this study included almost all age groups over a prolonged period (10 years).

One of this study's most important findings is a reduction in the average age of patients with skin cancer as compared to the last Saudi national registry report published in 2010 (58.9 years old vs. 68, respectively).[20] This is may be attributed to the increased awareness provided by the Ministry of Health, government workshops and conferences, and social media, as well as early diagnosis and therapeutic improvements. Nevertheless, UV radiation is the major factor leading to the development and progression of skin cancer.[6] The data presented here show that skin cancer is more prevalent in males than females (1.56:1 male:female). This distribution was expected considering that men typically experience greater sun exposure due to their daily chores, while females have less exposure and typically cover their faces and bodies with special black clothing known as Khimar.

In this study, BCC had the highest prevalence among tested patients, followed by SCC. A similar pattern of prevalence was reported in studies of other KSA regions.[9],[10],[11],[12],[13],[21] These data support several international reports showing BCC to be the most prevalent among other populations.[22],[23],[24] Interestingly, the findings of this study contradict those of Bahamdan and Morad,[24] which showed that SCC is the most common type of skin cancer in the southern region (Asser) of the KSA. This may be explained by geographic differences as the Riyadh region sits 600 meters above sea level while Asser has a higher elevation at 3000 meters above sea level. Further studies are required to accurately determine the risk factors responsible for this variation.

In any case, the face was the most common location for both BCC and SCC. This correlates with other local and international studies, possibly due to direct sun exposure in this location whereas the rest of the body is typically covered by clothing. These data are supported by many local and international studies.[9],[10],[11],[12],[13],[21],[22],[25] In general, the most common risk factor for developing BCC is skin color; it is more common in white-skinned people (Caucasians, Hispanics, and Asians) whereas SCC is more common in dark skin.[15],[26],[27] Other BCC risk factors include exposure to UV radiation therapy, light hair and eye color, European ancestry, inability to tan, scars, ulcers, immunosuppression, chronic infection, previous radiation, and genetic disorders such as albinism and xeroderma pigmentosa.[28]

Looking at SCC, risk factors include precursor lesions such as actinic keratosis and Bowen disease, UV radiation exposure, radiation therapy, exposure to environmental carcinogens such as arsenic, and aromatic hydrocarbons, immunosuppression, and viral hepatitis.[29] Due to insufficient data, it was difficult to determine the exact risk factors contributing to the high prevalence of BCC among the patients of this study and the high prevalence of facial BCC and SCC among patients. This should be considered in future studies.

Still, we found that MF is the third most common skin cancer among study individuals. In contrast to these data, MF ranks as the most common skin cancer in the southwestern region of the KSA, located on the Persian Gulf.[30] In Qassim, 400 km from Riyadh, no MF cases were reported between 2000 and 2009.[12] In Kuwait, the annual MF incidence is higher among Arab Asians than non-Arab Asians.[31] In additional, compared to Caucasians, black people are twice as likely to have MF, usually presenting with a more aggressive course.[32] Such variation in data could be attributed to misdiagnosis as the early stage of MF mimics benign inflammatory skin diseases such as eczema.[12],[30]

Furthermore, in this study, MM ranked as the fourth most common type of skin cancer among affected patients, presenting predominantly on the hips and lower limbs. Indeed, MM prevalence is high among those living in North America, Europe, Australia, and New Zealand, and lower in the Middle East.[33],[34] In addition, risk factors other than exposure to UV radiation play a crucial role in the development of MM.[35] In addition, we found that SC and KS were the least prevalent types of cancer; the majority of SC cases were located on the face while KS was mainly located on the hips and lower limbs. However, the most common variant of KS among Saudis is iatrogenic, typically affecting renal transplant patients.[36]

Although our data are still very interesting, some limitations may still exist. Most importantly is that the population of this study represent a random population form Saudi patients who have previously visited KAMC only. We still have no data regarding the visits of those patients to other hospitals or centers in the area. Besides, we could not obtain data from other medical centers in the Riyadh area. Besides, the risk factors and medications among those patients are still unknown to correlate these findings. Therefore, more extended similar studies from the different medical centers will widen the knowledge presented in this study.

  Conclusion Top

This study demonstrates that the incidence of skin cancer in the central area of the KSA exceeds other regions of Saudi Arabia, but is still lower than other international data. Regarding prevalence, BCC and SCC are the most common skin cancers, mainly occurring on the face. Further studies with more data regarding stress factors are highly recommended to understand underlying mechanisms and ultimately, increase public awareness.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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