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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 37-40

Facial skin cancers among yemenis patients: A prospective hospital-based study


1 Department of Oral and Maxillofacial Surgery, Al-Gomhory Teaching Hospital, Sana'a, Republic of Yemen
2 Department of Oral and Maxillofacial Surgery, Factuality of Dentistry, Al-Khartoum University, Al Khurtum, Republic of Sudan

Date of Web Publication21-Nov-2018

Correspondence Address:
Ali Ali Al-Zamzami
Al-Gomhory Teaching Hospital, Sana'a
Republic of Yemen
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dmr.dmr_3_18

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  Abstract 


Objective: the aim is to study the facial skin cancer among Yemenis, determine the common types, common sites, the pattern of the disease, and the possible risk factors associated with it. Materials and Methods: The study is a prospective descriptive hospital-based study carried out at Al-Gomhori Teaching Hospital in Sana'a. The material consisted of Yemen patients attending the Department of Oral and Maxillofacial Surgery and who were diagnosed clinically and histopathologically with having facial skin cancer. Patients who had previous treatment (surgical, radiation, or chemotherapy) or who have recurrent cancer, or who refused to participate in the study were excluded from the study. Results: During the study period, 100 cases of facial skin cancers were seen, 66 cases (66%) were male and 34 cases (34%) were female. The male-to-female ratio was 1.9–1. The majority of patients (94%) were over the age of 40 years, and the peak incidence was the 7th decade of life. Basal cell carcinoma was the most common type accounting for 72% followed by squamous cell carcinoma 27% and malignant melanoma 1%. The infra-orbital region was the most affected site accounting (21%), followed by the naso-labial region and the nose (18%) for each, the temporal region (14%) and the check (12%). Outdoor work was the main risk factor and associated with the development of 70% of facial skin cancer. Conclusion: Facial skin cancers in Yemen still remains the disease of the elderly and deprived patients. The majority of patients (94%) were over the age of 40 years. Males were affected more than females. The male to female ratio was 1.9-1. Basal cell carcinoma was the most common type. Infera-orbital region was the most affected site, followed by the Naso-labial region. Prolonged exposure to sunlight (outdoor work) was the main risk factor that play an important role to development of facial skin cancer among Yemenis.

Keywords: Cancer among Yemenis, facial cancers, facial skin cancer


How to cite this article:
Al-Zamzami AA, Suleiman AM. Facial skin cancers among yemenis patients: A prospective hospital-based study. Dent Med Res 2018;6:37-40

How to cite this URL:
Al-Zamzami AA, Suleiman AM. Facial skin cancers among yemenis patients: A prospective hospital-based study. Dent Med Res [serial online] 2018 [cited 2018 Dec 16];6:37-40. Available from: http://www.dmrjournal.org/text.asp?2018/6/2/37/245927




  Introduction Top


Most of the skin cancer arises in the sun-exposed regions of the head and neck.[1] According to the American Cancer Society, skin cancer accounts for about half of all cancers in the USA, and more than one million cases of skin cancer are diagnosed annually.[2] In developed countries were data are available, skin cancer incidence was increased. For example; In England, the incidence of skin cancer has increased from 173.5 to 265.4 per 100.000 per year. In countries with a phenotypic ally lighter-skinned population, the numbers are even higher. In Australia, the incidence of BCC is the world's largest, accounting for 726 cases (100,000 inhabitants/year). In Germany the incidence is 96 cases (100,000 inhabitants/year) for men and 95 cases (100,000 inhabitants/year) for women.[3],[4],[5],[6]

Basal cell carcinoma is the predominant histological type of skin cancer and accounts for about 90% of all cutaneous cancer in the head-and-neck region. It is more common in fair-skinned individuals, and it increases in incidence in communities closer to the equator or at higher altitudes.[1],[7]

Squamous cell carcinoma is the second most common type of cutaneous cancer. It usually develops in sun-exposed skin and can occur anywhere in the body.[1],[8]

Malignant melanoma is the last form of skin cancer an arises from melanocytes (which produce the melanin that gives the skin its color and protects it from sun damage). Its more common in people who are fair in complexion and in those living in geographic areas that are exposed to intense sunlight such as Australia.[1],[9],[10] Approximately 80% of skin cancer occur in the head-and-neck region, and the rest mainly in the trunk and lower limbs. In the head-and-neck region, the most common sites are the preauricular, the postauricular region, the floor of the nose, the columella, the nasolabial sulcus and the cheek area.[2]

The exposure to ultraviolet radiation (long-standing exposure to sunrays) is the main risk factor associated with developing facial skin cancers.[11],[12] A study by Armstrong BK[13] found that there is sufficient evidence about the carcinogenicity of solar radiation in humans. Sun exposure is a well-established major risk factor for the development of about 99% of nonmelanoma skin cancer and 95% of melanoma.


  Material and Methods Top


The present study is a prospective des-criptive hospital– based study carried out at Al-Gomhori–Teaching Hospital in Sana'a, which is the major referral center of oncology in Yemen. The material consisted 100 Yemen patients who attending to the Department of Oral and Maxillofacial Surgery and who were diagnosed clinically and histopathologically as having facial skin cancer. Patients who had previous treatment (surgical, radiation or chemo - therapy) or who had recurrent cancer were excluded. Data were collected from history (using a questionnaire form), clinical examination of patients, and from the histopathology results of the biopsies. Data was analyzed with the computer using SPSS program. P-value less than 0.05 is considered statically significant.


  Results Top


Out of 100 cases of facial skin cancers, 66 cases (66%) of them were males and 34 cases (34%) were females. The male to female ratio was 1.9-1. The majority of patients (94%) were over the age of 40 years. The peak age of occurrence was the seventh decade of the life [Table 1].
Table 1: Age/gender distribution of the facial skin cancers

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Basal cell carcinoma was the comments type accounting for (72%) following by sqaumous cell carcinoma (27%) and malignant melanoma (1%) [Table 2].
Table 2: Type distribution of the facial skin cancers

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Seventy-two cases of the series were basal cell carcinoma; 46 cases (63.9%) were male and 26 cases 36.1%) were female. The male-to-female ratio was 1.8-1. The majority of patients (95.9%) was over the age of 40 years, and the peak of occurrence was the 7th decade of life [Table 3].
Table 3: Age/gender distribution of basal cell carcinoma on the facial skin

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The infra-orbital region was the most common affected site accounting (23.6%) followed by the nasolabial region and the nose (22.2%) for each site, the temporal region (13.9%), the cheek and the frontal region (5.6%) for each site, and the preauricular region and acanthus (4.2%) for each site [Table 4].
Table 4: Site distribution of basal cell carcinoma of the facial skin

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The 2nd common type of facial skin cancers was squamous cell carcinoma, 27 cases of this type were found, 19 cases (70.4%) were male and 8 cases (29.6%) were female. The majority of patients (92.6%) were over the age of 40 years and the peak of occurrence was the 7th and 8th decades of life. The male-to-female ratio was 2.4-1 [Table 5].
Table 5: Age/gender distribution of sqaumous cell carcinoma of the facial skin

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The cheek region was the most common affected site (29.6%) followed by the temporal and preauricular regions each accounting for 18.5%. The infra-orbital region, the nose, the nasolabial regions and the frontal region accounted for (14.8%), (7.4%), (7.4%), and (3.7%), respectively [Table 6].
Table 6: Site distribution of sqaumous cell carcinoma of the facial skin

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The infra-orbital region was the most frequent site accounting (21.0%), followed by the nasolabial region and the nose (18.0%) for each site, the temporal region (14.0%), the cheek (12.0%), the preauricular region (8.0%) the frontal region (6.0%), and the canthi region (3.0%) [Table 7].
Table 7: Site distribution of the facial skin cancers

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Outdoor work was the main risk factor accounting (70%), followed by fair skin (26%), trauma (18%), hereditary disorders (3%), and radiotherapy treatment (2.0%) [Table 8].
Table 8: Risk factors distribution of facial skin cancers

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Out of the 100 cases of facial skin cancers, 70 cases were outdoor workers, 44 cases of them (44%) were male and 26 cases (26%) were female [Table 9].
Table 9: Relationship between outdoor work/gender

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Outdoor work was associated with the developing of 81.5% of squamous cell carcinoma and 66.7% of basal cell carcinoma on the facial skin region [Table 10].
Table 10: The relation shape between outdoor work and the type of the facial skin cancers

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Outdoor work was associated with developing 83.3% of nasolabial cancers, 76.2% of the infra-orbital cancers, 72.2% of the nose cancers, 66.7% of the check cancers, 64.3% of temporal cancers, 62.5% of the preauricular cancers, 50% of frontal cancers, and 33.3% of the acanthi cancers. Fair skin, trauma, hereditary disorder, and radiotherapy treatment were other risk factors that have an insignificant role in the causation of facial cancers [Table 11].
Table 11: Outdoor work in relation to the site of the facial skin cancers

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  Discussion Top


In this study, basal cell carcinoma was the commonest type of facial skin cancer, accounting for 72% of facial skin cancer, followed by sqaumous cell carcinoma [Table 2]. The same findings were reported by Valquiri PC and Sylvie E who founds that, the non-melanocytic cancer (Basal cell carcinoma and sqaumous cell carcinoma) were the most common type of facial skin cancer, especially in fair – skinned individuals and in transplant recipient patients. They also, pointed to that, the basal cell carcinoma accounted for 70 % to 80% of facial skin cancers.[14],[15]

In the present study, the infra-orbital region, followed by the nasolabial region, the nose, and the temporal region were the most involved site, respectively. The less involved sites were the cheek, the preauricular region, the frontal region and the canthi (with a frequency of <10% for each site. The same observations were reported by Swanson[16] who demonstrated that, the high-risk sites fall within an “ H” zone on the face. The author highlighted the junction of the alla with the nasolabial fold, the nasal septum, the nasal alla, the inner acanthi and the lower eyelids of the preorbital region as specific regions at risk. However, Mohs[17] reported findings that are different from the findings of this study and from those reported by Swanson. The investigator found that the common site of facial cancers were the pre- and post-auricular region, the floor of the nose, the columella, the nasolabial sulcus and the cheek.

In the present study, the majority of patients (94%) were over the age of 40 years (two cases were <15 years of the age. The two cases were xeroderma pigmentosum which is usually associated with the development of skin cancer). The males were more affected than the females. These findings are in agreement to report by Miller and Weinstockand Han et al.[18],[19] who showed males more affected than females and the majority of patients were in the 7th and 8th decades of life. The mean age at the time of diagnosis of melanoma cases was 63.4 years, and that of squamous cell carcinoma cases and basal cell carcinoma cases was 64.7 and 64.0 years, respectively.

The same findings were reported by Marks et al.[20] from Australia and Valquiria in 2011 in Brazil,[14] who found that the majority of these patients were between the age of 60 and 80 years.

In the present study, outdoor work (long-standing exposure to sunlight) was the main risk factor associated with the development of facial skin cancers. The findings of this study were similar to those in the literature.[11],[12] According to Jackson[21] people who are fair in complexion (fair skin, light hair blue, or green eyes) have a tendency to sunburn and a relative risk of developing facial skin cancer. This is further supported by the low rates of skin cancers in people whose skin is relatively more pigmented.[22],[23]


  Conclusion Top


Facial skin cancers in Yemen is still remains the disease of the elderly and deprived patients, particularly those who spend long time exposure to sunlight such as, farmers and fisherman. The majority of patients (94%) were over the age of 40 years. Males were affected more than females. The male to female ratio was 1.9-1. Basal cell carcinoma was the most common type and accounting 72 % of all facial skin cancers. Infera-orbital region was the most affected site and 21.0% of facial skin cancers were reported in this site, followed by the Naso-labial region 18.0%. Outdoor work (prolonged exposure to sunlight) was the main risk factor that play an important role to development of facial skin cancers and seventy percent of all facial skin cancer patients were outdoor works. Outdoor work was responsible to developing 81.5% of sqaumous cell carcinoma and 66.7% of basal cell carcinoma on the facial skin region.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Byron J, Karen H, Paul A, Jeffrey R, Gerald B, Harold C, et al. Textbook of Head and Neck Surgery, Otolaryngology. 3rd ed., Vol. 2. U.S.A: Lippincott Williams and Wilkins; 2001. p. 1222.  Back to cited text no. 1
    
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Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med 2005;353:2262-9.  Back to cited text no. 2
    
3.
Geller AC, Annas GD. Epidemiology of melanoma and nonmelanoma skin cancer. Semin Oncol Nurs 2003;19:2-11.  Back to cited text no. 3
    
4.
van Hattem S, Aarts MJ, Louwman WJ, Neumann HA, Coebergh JW, Looman CW, et al. Increase in basal cell carcinoma incidence steepest in individuals with high socioeconomic status: Results of a cancer registry study in the Netherlands. Br J Dermatol 2009;161:840-5.  Back to cited text no. 4
    
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Diepgen TL, Mahler V. The epidemiology of skin cancer. Br J Dermatol 2002;146 Suppl 61:1-6.  Back to cited text no. 5
    
6.
Madan V, Lear JT, Szeimies RM. Non-melanoma skin cancer. Lancet 2010;375:673-85.  Back to cited text no. 6
    
7.
Basal Cell Carcinoma. Classification and External Resources; 2007. Available from: http://www.Wikipedia.org.entprint.  Back to cited text no. 7
    
8.
Regezi A, Sciubba J. Textbook of Oral Pathology, Clinical Pathologic Correlations. 3rd ed. London: W.B. Saunders Company; 1999. p. 69-81.  Back to cited text no. 8
    
9.
Melanoma of the Skin. Type of Melanoma, Staging and Treatment. Skin Cancer Guide. Ca; 2007. Available from: http://www.cancer.ca./entprint.  Back to cited text no. 9
    
10.
Ozyazgan I, Kontaş O. Previous injuries or scars as risk factors for the development of basal cell carcinoma. Scand J Plast Reconstr Surg Hand Surg 2004;38:11-5.  Back to cited text no. 10
    
11.
Kyrgidis A, Tzellos TG, Vahtsevanos K, Triaridis S. New concepts for basal cell carcinoma. Demographic, clinical, histological risk factors, and biomarkers. A systematic review of evidence regarding risk for tumor development, susceptibility for second primary and recurrence. J Surg Res 2010;159:545-56.  Back to cited text no. 11
    
12.
Armstrong BK, Kricker A. The epidemiology of UV induced skin cancer. J Photochem Photobiol B 2001;63:8-18.  Back to cited text no. 12
    
13.
Armstrong BK. How sun exposure causes skin cancer: An epidemiological perspective. Prevention of Skin Cancer. Dordrecht, the Netherlands: Kluwer Academic Publishers; 2004. p. 89-1160.  Back to cited text no. 13
    
14.
Valquiri PC, Helio AM. Epidemiology of basal cell carcinoma. An Bras Dermatol 2011;86:292-305.  Back to cited text no. 14
    
15.
Sylvie E, JeanK, Alain C. Skin cancers after organ transplantation. NEJ Med 2003;348:168-91.  Back to cited text no. 15
    
16.
Swanson NA. Mohs surgery. Technique, indications, applications, and the future. Arch Dermatol 1983;119:761-73.  Back to cited text no. 16
    
17.
Mohs FE. Chemo-surgery for the microscopically controlled excision of skin cancer. J Surg Oncol 1997;3:257-67  Back to cited text no. 17
    
18.
Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: Incidence. J Am Acad Dermatol 1994;30:774-8.  Back to cited text no. 18
    
19.
Han J, Colditz GA, Hunter DJ. Risk factors for skin cancers: A nested case-control study within the nurses' health study. Int J Epidemiol 2006;35:1514-21.  Back to cited text no. 19
    
20.
Marks R, Staples M, Giles GG. Trends in non-melanocytic skin cancer treated in Australia: The second national survey. Int J Cancer 1993;53:585-90.  Back to cited text no. 20
    
21.
Jackson BA. Nonmelanoma skin cancer in persons of color. Semin Cutan Med Surg 2009;28:93-5.  Back to cited text no. 21
    
22.
Robert S, Bader MD. Basal Cell Carcinoma. American Society for Dermatological Surgery; 2006. Available from: http://www.medicine.com.entprint.  Back to cited text no. 22
    
23.
de Vries E, Louwman M, Bastiaens M, de Gruijl F, Coebergh JW. Rapid and continuous increases in incidence rates of basal cell carcinoma in the Southeast Netherlands since 1973. J Invest Dermatol 2004;123:634-8.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]



 

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