Objective: The study was undertaken to document the presentation and outcome of cutaneous malignancies in our set up.
Study Design: Descriptive study.
Place and Duration: This study was carried out in the Department of Plastic and Reconstructive Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad during the period from July 01, 2006 to June 30, 2008.
Materials and Methods: All patients who presented with various cutaneous malignancies at our department were included in the study by convenience sampling technique. Those patients who did not consent to participate in the study were excluded. Initial assessment and diagnosis was made by history, physical examination and fine needle aspiration cytology (FNAC). Wedge / excision biopsies were performed in all patients. Local extent of tumour was assessed with CT scan in selected patients. The sociodemographic profile of the patients, type of malignancy, type of surgical procedure undertaken, complications encountered, morbidity and mortality were all recorded on a proforma. The data were subjected to statistical analysis.
Results: Out of a total of 103 patients, 56.31% (n=58) were males while 43.68 % (n=45) were females. The mean age was 53 ± 17 years. There were 55 cases of BCC, 40 cases of SCC, 6 cases of malignant melanoma, and one case each of trichilemmal carcinoma and dermatofibro-sarcoma protuberance (DFSP). Face was the most frequent site of involvement ( n=72 ), followed by leg ( n=9 ), neck ( n=6 ), arm ( n=5 ), scalp ( n=4 ), hand ( n=3 ), chest ( n=2 ), and back ( n=2).
The rate of hospitalisation was 12.62%(n=13). The average hospital stay was 5 days (range 3-9days). There was no in-hospital mortality.
Conclusion: Cutaneous malignancies constitute a significant source of morbidity and hospitalization especially in the elderly population. In our set up, BCC constitutes the leading type followed by SCC. Painless skin lesion of a relatively longer duration is the usual presenting feature. Surgical excision and reconstruction of the defect with skin graft or flap is the most frequently instituted definitive treatment. A good percentage of our patients present late with locally advanced cancer and are not amenable to surgical excision, necessitating radiotherapy or chemotherapy.
Key words: Cutaneous malignancies. Non-melanoma skin cancers. Basal cell carcinoma. Squamous cell carcinoma. Malignant melanoma.

Introduction

Cutaneous malignancies constitute one of the most common human malignancies. Annually, more than 400,000 people find out they have skin cancer. Etiology is related to various factors such as skin type, age, sun exposure and many other factors. Predisposing factors include individuals with a fair or light complexion, a history of severe sunburns, poor tanning capability, inherited disorders (e.g. xeroderma pigmentosa, albinism etc.), and immunocompromise etc. ^1-3 A linear correlation exists between the frequency of skin cancer and the amount of ultraviolet (UV) light exposure. The exaggerated and repeated exposure to UV light emanating from the sun is regarded as the most important risk factor for skin cancer. This exposure is increased owing to depletion of ozone layer which normally restricts the transmission of type B and C UV light. Early recognition and biopsy of suspected lesions greatly improves outcomes. ^{4, 5}
The skin cancers are classified into melanomas and non-melanoma skin cancers (NMSC). Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) are the commonest types of non melanoma skin cancers2. Although having greater incidence, the mortality of BCC and SCC is still low as compared to the alarmingly high mortality of malignant melanoma. 6 Malignant melanoma poses an emerging challenge as increasingly number of individuals are affected by it. Its incidence is estimated to be rising by almost 6% per year. ^{7, 8}
Cutaneous malignancies are not uncommon in our population. Most of our patients present with fairly advanced stage. The present study was undertaken to measure the frequency of cutaneous malignancies in our set up, analyse the sociodemographic profile of the patients, assess the associated morbidity and mortality and collect actionable evidence base for evolving meaningful strategies to address this emerging public health issue.

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