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[Cancer Biology & Therapy 4:5, 593-595; May 2005]; ©2005 Landes Bioscience

Skin Cancer in Egypt


Research Paper

A Word in Your Ear


Mahmoud R. Hussein ABSTRACT
Former Address: University of Wisconsin Medical School and William S. Middleton Background and Objectives: In Egypt, the clinicopathologic features of skin cancer are
Memorial Veteran Hospital; Madison, Wisconsin 53705 USA; Tel.: 608.256.1901x still unknown.
17818 Materials and Methods: To define these features, registries of the Pathology Departments,
Correspondence to: Mahmoud R. Hussein; Lecturer of Pathology; Department of Assiut and South Valley University Hospitals were reviewed. The lesions included 21

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Pathology; Faculty of Medicine; Assiut University; Assiut, Egypt; Tel.: 093.583.166;

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melanomas, 39 squamous cell carcinomas (SCCs), and 202 basal cell carcinomas
Fax: 088.333.327; Email: mrh17@swissinfo.org

UT
(BCCs).
Received 01/11/05; Accepted 04/11/05 Results: Skin cancer represented 5% of the malignant tumors of the entire body. BCC
Previously published online as a Cancer Biology & Therapy E-publication:
(77%) was the most common skin cancer followed by SCC (15%) and melanomas (8%).

RIB
http://www.landesbioscience.com/journals/cbt/abstract.php?id=1730 The mean age was 54 ± 3 (melanomas), 66 ± 10 (BCC), and 60 ± 5.18 (SCC). The
most common sites were the face (BCCs), face and extremities (SCCs), and face and
KEY WORDS

IST
lower limbs (melanomas). The average size (mm) was 21 ± 0.3 (melanomas), 28 ± 0.3
(BCC) and 30 ± 1.1 (SCC). Melanomas, BCCs and SCCs were of nodular, keratotic
melanoma, squamous cell carcinoma, basal cell invasive and nodular infiltrative types, respectively.

D
carcinoma Conclusions: In Egypt, skin cancer is uncommon malignancy. As compared to Western
societies, the incidence rate of melanoma is very low and its topographic distribution is

OT
different. Alternatively, the rates for SCCs/BCCs are comparably high and their topo-
graphic distribution is similar. This is the first investigation that reports the clinicopathologic
ON
features of skin cancer in Egypt and compares it to other parts of Africa and Western
societies.
.D

INTRODUCTON
CE

Skin cancer is a common malignancy worldwide. In USA, melanoma represents 4% of


IEN

all new cancers whereas incidence of non-melanoma skin cancer (NMSC) is nearly equal
to that of all non-cutaneous cancers.1,2 Similarly, in Africa, South Africans have very high
rates of skin cancer.3 The development of NMSC, including both squamous cell carcinomas,
SC

(SCCs, 20%) and basal cell carcinomas, (BCCs, 80%), is related to ultraviolet light (UV).4,5
BIO

Alternatively, etiology of melanoma is either due to genetic defects (familial melanoma) or


interactions of low-penetrance genes, and UV (sporadic melanoma).4 To date, literature
about skin cancer is limited to Western societies with a few available studies about it in
Africa.3 Also, no reports are available about skin cancer in Egypt. Thus this study was
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conducted to fill this existing gap in literature.

MATERIALS AND METHODS


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The Assiut and South Valley University. Hospitals are the major medical centers with Oncology
clinics dealing with skin cancer in the entire region of The Upper Egypt. This study examined the
registries of the Pathology Departments at these University Hospitals. These Registries include
05

reports that come from the Pathology laboratories; general hospitals, private clinics and governmental
health care units scattered throughout Upper Egypt. Thus, although this study is only a hospital
20

based one, data retrieved from these registries and presented in this study reflect the status of skin
cancer in the community of the entire region. The relevant data (published work) about skin cancer
©

in USA and some African countries were reviewed and compared with data obtained from the
registries of these Hospitals.1,6 The study population has an Arab background (Caucasians) and
wheatish to brownish complexions. A total of 42,400 pathology accessions were reviewed
(1989–2004) with 262 skin cancers being included. The cases included 21 melanomas, 39 SCCs
and 202 BCCs. The clinicopathologic characteristics were reviewed. These cases were reviewed by
the author to determine their suitability for the study. The cases in which the morphologic diagnosis
was not definitive were reviewed by another pathologists to establish a consensus. The representation
of skin cancer was compared with the proportion of other tumors in the same population (surgical
biopsy accessions from 1989–2004). The following characteristics were recorded for these lesions:

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Skin Cancer in Egypt

Table 1 Comparison of the clinicopathologic features of skin cancer among USA, Egypt and some African countries

Aspect BCCs SCCs CMMs


Egypt USA Nigeria Egypt USA Tanzania Egypt USA Nigeria
Incidence 77% 60–75% ? 15% 5–10% ? 8% 4% 4.5%
Age 55–90 55–75 30–40 50–60 60–70 40–49 40–62 40–53 50–70
Sex (M:F) 1.6:1 2:1 ? 2:1 2:1 M>F 2.2:1 1.1:1 2:1
Site Face/forehead Face/nose Face/forehead Face/L.L Face/ear L.L/H&N Face/legs Trunk/leg Legs
Type Nodular Nodulo- Ulcer Keratotic Ulcer Ulcer Nodular SSM Nodular
infiltrative ulcerative invasive

Comparison of the clinicopathologic features of skin cancer among USA, Egypt and some African countries. SCCs, Squamous cell carcinoma; BCCs, basal cell carcinoma; CMMs, cutaneous malignant melanomas. M, male;
F, female; SSM, superficially spreading melanomas; L.L, lower limbs; H&N, head and neck.

sex, age, tumor size and location of the primary tumor including metastases the weakening of the immune system by, disease or medication helps
if present as well as the morphology of the neoplastic cells. explain predilection for late adult life. It is still possible that elderly
Clinical diagnosis of these lesions was done at the departments of peoples have problems in recognizing changes in their skin lesions,
Dermatology and Plastic Surgery following the criteria mentioned by other thus diagnosis is delayed. Egypt has a hot sunny climate and therefore,
groups. Squamous cell carcinoma was diagnosed clinically by the presence people wear less clothing. These dressing habits together with fre-
of one or combinations of the following lesions: (1) an erythematous, ulcer-
quency of skin cancer on sun-exposed areas in Egypt suggest UV as
ated, crusting lesion, (2) or area of persistent ulceration, (3) hyperkeratotic
patch and (4) nodules. The clinical diagnosis of BCC was made when one
a possible contributor to cutaneous tumorigenesis. Moreover, the
of the following varieties was encountered: (1) nodular (waxy papules, ulcer- increased incidence of skin cancer in the face and foot may be due
ation or telangiectases), (2) pigmented (lesion of increased brown or black to the increased density and instability of melanocytes and ker-
pigment), (3) cystic (translucent blue-gray cystic nodules), (4) superficial atinocytes.4
(scaly patches or papules), (5) micronodular (yellow-white when stretched), Skin cancer in Egypt compared to other African countries. As
and (6) morpheaform and infiltrating (scarlike plaques or papules). compared to other African countries (Tanzania, Nigeria and South
Diagnosis of melanoma was established by identification of one of its four Africa), NMSC differed in two aspects. First, BCCs were more
major clinical-histopathologic subtypes (superficial spreading, nodular, common than SCCs. Second, the genital areas (penis and vulva)
lentigo maligna, and acral lentiginous melanomas).7,8 Alternatively the histo- were not involved, probably be due to lack of predisposing risk
logical diagnosis and classification of these tumors was done by certified factor (smegma of the uncircumcised penis and chronic irrita-
pathologists following other groups.9,10
tion).11,12,15 Melanomas among Egyptians share three aspects with

RESULTS
other African countries. First, it is a rare neoplasm as compared to
Western societies. Second, it has site predilection for the face and
Skin cancer represented 5% of the malignant tumors of the entire body. legs. Third, it is the disease of elderly males.1,2
BCCs (77%) was the most common skin cancer followed by SCCs (15%), Skin cancer in Egypt compared to Western societies. As compared
and melanomas (8%). The mean age was 54 ± 3 (melanomas), 66 ± 10 to Western societies, melanomas among Egyptians differ in being:
(BCCs), and 60 ± 5.2 (SCCs). These lesions were more common in males (1) rare neoplasms, (2) have a definite male sex predilection with
than in females (2.2:1, 2:1, 1.6:1, for melanomas, SCCs and BCCs, respec- older age incidence, and (3) of nodular growth pattern. Alternatively,
tively). The most common sites were the face (BCCs), face and extremities skin cancer in our locality shares four features with Western societies:
(SCCs), and face and lower limbs (melanomas). The average size (mm) was (1) NMSC is more common than melanomas, and (2) BCCs are
21 ± 0.3 (melanomas), 28 ± 0.3 (BCCs), and 30 ± 1.1 (SCCs). Melanomas, more common than SCCs. The rarity of melanoma in Egypt may be
BCCs, and SCCs were of nodular, keratotic invasive and nodular infiltrative
due to (1) lack of genetic predisposition and (2) amelioration of the
types, respectively (Table 1).
effects of sun exposure by the relative impenetrability of the wheatish
DISCUSSION
to black skin of the Egyptians to UV.5,16,17
To summarize, our study indicates that skin cancer is an uncommon
This study provides a baseline information about skin cancer in disease in Egypt that affects both elderly males and females. The
Egypt. Its data clearly demonstrated that skin cancer in Egypt: (1) is significance of this investigation stems from the fact that it is the first
uncommon malignancy that affects elderly, male population, and one (since the British Colonial rule) to report the clinicopathologic
(2) has some similar and different features as compared to Western features of skin cancer in Egypt. Also, it compares this disease
societies and other African countries. process (skin cancer) among different regions in the world. The
In Egypt, skin cancer is common among elderly males and its underlying reasons for the differences between clinicopathologic
etiology may be related to sun exposure. In this study, the prevalence features of skin cancer in Egypt, African countries and USA remain
of the skin cancer in males than in females of late adult life not only open for further investigations.
concurs others reports (Western societies, Tanzania, Nigeria, and
South Africa) but also suggests that its development is a lengthy
process.1-3,11-14 The male sex predilection of skin cancer in Egypt is
explained by the fact that men represent the main workforce (outdoor
work) with more risk for UV exposure than women.4 Alternatively,

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Skin Cancer in Egypt

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