Distribution of cutaneous malignancies in Eastern Rajasthan: A five-year study

Phanindra K Swain; Suresh Singh; Bhushan S Bhalgat; Pravin Kumar; Kamal K Lakhera; Pinakin Patel; Raj G Sharma

doi:10.4103/ijd.ijd_953_21

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Year : 2022 | Volume : 67 | Issue : 6 | Page : 728-731

Distribution of cutaneous malignancies in Eastern Rajasthan: A five-year study

Phanindra K Swain, Suresh Singh, Bhushan S Bhalgat, Pravin Kumar, Kamal K Lakhera, Pinakin Patel, Raj G Sharma
From the Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Date of Web Publication

23-Feb-2023

Correspondence Address:
Phanindra K Swain
Senior Resident, Department of Surgical Oncology, SMS Medical College, Jaipur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijd.ijd_953_21

Abstract

Background: Cutaneous malignancies are rare with respect to other malignancies. The distribution of various histologies of these malignancies is not uniform. We aimed to study the distribution of these malignancies and their epidemiological pattern in Eastern Rajasthan with the data collected from various pathology labs in Jaipur. Methods: In this retrospective chart review we analysed the data of 453 patients presenting with histopathologically proven cutaneous malignancies to four major pathology departments and labs in Jaipur, Rajasthan. We recorded the distribution of these histologies according to incidence, age of presentation, gender and site predilection. The data was subsequently analysed using statistical methods. Results: Squamous cell carcinoma (36%)was the most common histology which was closely followed by basal cell carcinoma(31%). Malignant melanoma (13%) was the third most common histology to present. Other less common histologies to present were dermatofibrosarcoma, Kaposi sarcoma, non hidgkin lymphoma etc. The age range varied from 14 to 90 years. The mean age of presentation was 54.3 years. Male had a slight preponderance (1.36 times more than females)overall. Except Bcc, which had a female preponderance. Head and neck(38.41%) was the most common site to be affected overall followed by lower limbs(31.56%). Interpretation: The idea of distribution of these rare malignancies in our part of the country will not only help us in proper surgical management but also in educating the public about the possible causes and the need for early intervention leading to better prognosis.

Keywords: Cutaneous malignancies, distribution, eastern Rajasthan, histology, Jaipur

How to cite this article:
Swain PK, Singh S, Bhalgat BS, Kumar P, Lakhera KK, Patel P, Sharma RG. Distribution of cutaneous malignancies in Eastern Rajasthan: A five-year study. Indian J Dermatol 2022;67:728-31

How to cite this URL:
Swain PK, Singh S, Bhalgat BS, Kumar P, Lakhera KK, Patel P, Sharma RG. Distribution of cutaneous malignancies in Eastern Rajasthan: A five-year study. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 23];67:728-31. Available from: https://www.e-ijd.org/text.asp?2022/67/6/728/370357

Introduction

Though skin is the largest organ of the body, the incidence of cutaneous malignancies is rare. They are found to be more common in United States, Europe, Australia, and New Zealand.^[1],[2],[3] The three most common primary skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma. BCC and SCC—in combination referred to as nonmelanoma skin cancers (NMSC)—and malignant melanoma are common in white populations.^[4] NMSC is responsible for over one million new cases (excluding BCC) and 64,000 deaths globally, with incidence rates approximately two-times higher among men than among women.^[5]

In India, the incidence of skin malignancies is low, constituting about 1%–2% of all diagnosed cancers. BCC in the most common skin cancer worldwide, but various studies from India have reported SCC as the most prevalent skin malignancy.^[6],[7]

The purpose of our study was to decipher the histological patterns of various types of skin malignancies presenting to various pathological laboratories in Jaipur. Jaipur, being the capital and major health hub of the state of Rajasthan, receives the major bulk of all cases presenting in the state.

Patients and Methods

This descriptive study spanned over five years (August 2016- July 2021) and was based on retrospective chart review analysis of 453 patients by the Surgical Oncology Department of SMS Medical College, Jaipur. Data was collected from four major pathology departments in Jaipur, namely, S.M.S. Medical College, S.D.M Hospital, Bhagwan Mahavir Cancer Hospital, and Dr. K. C. Joshi Diagnostic Lab. These pathology centres are expected to receive the major volume of cases presenting to eastern Rajasthan, and hence provide us an ideal sample for the study. Only cases with histologically proven skin malignancy were included. Ethical clearance from the institutional ethical committee was taken. Incomplete and duplicate data were sorted out and discarded. Overall incidence of histological patterns, age, and gender distribution and site preponderance were recorded.

Statistical analysis

The statistical analysis was descriptive and was carried out using the Statistical Package for the Social Sciences (SPSS) version 26.0 for Windows.

Results

During our five-year study period, we reviewed the histopathology reports of 453 patients presenting with skin malignancies. Histological patterns with comparatively fewer number of cases were grouped under miscellaneous. It included malignant round cell tumour, non-Hodgkin's lymphoma, metastatic adenocarcinoma, sebaceous gland carcinoma, and trichilemmal tumours. It included 263 males and 190 females (ratio = 1.36:1).

[Figure 1] shows the frequency distribution of the histological patterns in the population. SCC comprised around 36% of cases followed by BCC (31%). Malignant melanoma, dermatofibrosarcoma, Kaposi's sarcoma, and miscellaneous tumours constituted 13%, 6%, 4%, and 10%, respectively.

Figure 1: Frequency distribution of the histological patterns in the population

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[Table 1] shows the relative frequency and age distribution of various malignancies. The age distribution was between 14 and 90 years. The majority of cases were distributed in the fourth, fifth, and sixth decades of life which accounted for 62.69% of cases. No cases below 10 years of age were detected.

Table 1: The relative frequency and age of distribution of various malignancies

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[Table 2] shows the median age of presentation for individual histologies and gender distribution across them. SCC was more commonly seen in males in comparison to BCC which had a female preponderance. Other histological entities had male preponderance. The most common cutaneous malignancy found in males was SCC, whereas in females it was BCC. Males were more commonly involved in SCC compared to other carcinomas, and this association was found to be statistically significant whereas females were more commonly involved in BCC compared to other carcinomas. Median age of dermatofibrosarcoma and Kaposi's sarcoma was significantly lesser compared to other carcinomas (P-value < 0.001).

Table 2: The median age of presentation for individual histologies and gender distribution across them

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[Table 3] shows the site-specific presentation of various histologies. Head and neck covered the majority of cases (38.41%) followed closely by lower limb (31.56%). SCC and BCC had a head and neck predilection (41.9% and 60.8%, respectively). In contrast, other histologies had a predominantly lower limb predilection.

Table 3: The site specific presentation of various histologies

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Discussion

Around 1%–2% of all malignancies in India are cutaneous malignancies. Worldwide, BCC accounts for a major burden with occurrence of up to 60%–70%; however, it carries a better prognosis as it has low propensity to spread.^[8] However in our study, SCC was the most common malignancy reported in northwestern India during the study period. Our study corroborates with the results of the study by Sharma et al.^[7] where SCC accounted for 53% of cases. However, results of Lal et al.^[9] found BCC to be reportedin 54% cases with SCC in 36% cases.

Mean age of diagnosis was 48 years. Age range varied from 14 to 90 years. This is almost similar to the results of a study by Azad et al.^[10] which had 55.8 years as mean age.^[10] Several studies have indicated that 70% of all skin cancers occurred in sixth, seventh, and later decades.^[11] But in our study, 62.69% of cases belonged to the fourth, fifth, and sixth decades of life. In our study, males had a higher preponderance in comparison to females (ratio 1.36:1). This corresponds to findings of various studies.^[12],[13] However, a study by Supekar et al.^[14] had higher female preponderance (1.53:1).

Head and neck regions are the most common sites of cutaneous malignancies.^[10] Our study population showed similar results only for SCC and BCC. Other types like melanoma, dermatofibrosarcoma, Kaposi's sarcoma, and miscellaneous tumours had lower limb as the most common site of involvement.

Melanoma was the third most common malignancy found in our study. Although it comprises about 3% of all skin cancers, it accounts for about 75% of all skin cancer deaths.^[15] In our study, it had a sight male preponderance. This corresponds to a study in India by Sharma et al.^[16]

Other rare tumours reported in our study were dermatofibrosarcoma and Kaposi's sarcoma. However, due to limited data availability we could not draw any conclusion about the link between HIV status and Kaposi's sarcoma. Sebaceous gland adenocarcinoma was found in only one case. Nine cases of malignant round cell neoplasm were reported, the tmmunohistochemistry reports of which could not be collected.

Due to unavailability of proper history of the patients reported, we could not draw any conclusion about exposure to sunlight and head and neck preponderance of SCC and BCC in our study. Although Jaipur receives the highest volume of patient load from Rajasthan and nearby states, there is still patient outflow to other oncology centres present in its vicinity. Our study may thus be undermining the actual incidence in the northwestern state. These were the limitations of the study, to the best of our knowledge.

Conclusion

Cutaneous malignancy comprises a very less case load among cancers presenting in our state. However, the knowledge about the trends of their histologies will give us an idea about proper surgical management and help us explain to patients about the possible prognosis.

Acknowledgement

We extend our gratitude to the Department of Pathology, S.M.S. Medical College & Hospital, Jaipur; late Dr. B. C. Sangam, Department of Pathology, S.D.M. Hospital, Jaipur; Bhagwan Mahavir Cancer Hospital, Jaipur; Dr. K. C. Joshi Diagnostic Lab, Jaipur for their valuable contributions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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