Retrospective analysis and evaluation of recurrence rates of malignant skin cancer

Malignant skin tumors mainly include basal cell cancer (BCC), squamous cell cancer (SCC) and malignant melanoma (MM), basosquamous carcinoma and skin adnexal tumors. The biological features of these cancers are slightly different, and the vast majority of these cases are basal cell carcinomas. Respectively, squamous cell cancer, malignant melanoma and skin adnexial tumors are listed. The aim of this study is to analyse the skin cancered patients epidemiological features, identify the common sites and histopathological features and retrospectively determine the treatment algorithm and recurrence rates. This study is verified among 1280 treated patients presenting with malignant skin lesions at the Celal Bayar University Plastic, Esthetic and Reconstructive Surgery Clinic in years between January 1995- December 2014. 701 of patients were male (%54,8), 579 (%45,2) were female. İnternational articles also notify that skin cancers are more common in male sex. Avarage age was determined as 65,6 years (min:20, max:97). All 1280 patients had totally 1436 lesions and these lesions were measured to have the size of 15,8mm (min:1, max:30cm). The most common site of the tumors was reported to be head and neck. The most frequent histopathological diagnosis was BCC with a rate of %60, after that %29,6 SCC, %5,5 MM, %3,8 skin adnexial tumors, %1,6 basosquamous carsinomas, respectively. Most of other studies indicate to have similar frequency sequence (101,102,103). The mean age of the patients with BCC was 65,2 years. %48,2 of these patients were female, %51,7 were male. The head and neck was reported as the most common site of the tumor. The mean age of the patients with SCC was 67,6 years. SCC is directly related with cumulative sun damage and age. Eventually sun exposed parts of body such as head, neck and extremities have higher risk of developing the cancer. In our study %39,7 of the patients were female, %60,2 were male and the most common site of the tumor was head and neck. MM is the third frequently reported skin cancer (101,102,114). Also in our case with a rate of %5,5 the third frequent type was MM. The mean age of the patients was 60,9 years. Results showed that %50,6 of patients were female, %49,3 were male, and the most common sites of tumor was cheek and foot, secondly the trunk. Histopathological researches indicated %26,7 of the patients had noduler malignant melanoma, %22,5 of patients had superficial spreading malignant melanoma, %22,5 patients had acral lentiginous malignant melanoma, %18,3 had lentigo maligna melanoma, %9,8 had in situ melanoma, respectively. The mean age of the patients with skin adnexial tumors was 60,3 years. %50 of patients were reported as female, %50 of patients were male. İt was shown that this type of tumor is frequently located in trunk, secondly the scalp, and less seen in other parts of the body. The mean age of the patients with basosquamous carcinomas was 72,1 years. %43,4 of patients were female, %56,5 were male. This tumor is most commonly (30,4) seen on nose. Datas of 70 of all patients with malignant melanoma were accessible, and the average thickness of these patients were 4,33 mm. Karasoy et al have reported that at the moment of diagnosis, Clark level of most of the cases were 4 (117). In our study, it was reported that %61 of our patients Clark level were 4. Similar results in epidemiological researches in our country point out the significance of early diagnose and consciousness-raising of the society. The rate of the patients that were treated with primary closure was %33,2. After the excision of the lesion, %29,7 of patients were treated with skin grafting, %38,5 of patients were treated witf flaps. %1,6 of patients were performed amputation. 38 (%2,9) of the patients had regional lymph node dissection, 16 of these patients had MM, 22 had SCC. In post-operative period, recurrence rates of patients who show up regularly for follow-up examinations were determined as %4,5. The location and size of tumor, histopathological features, treatment method, the experience of surgeon may affect the rates of recurrence. Recurrence rates were %3,3 among 765 patients with BCC, %6,7 among 373 patients with SCC, %6,6 among 75 patients with MM, %1,9 among 52 patients with skin adnexial tumors, %5,2 among 19 patients with basosquamous carcinoma. All of recurerrences of BCC, and %80 of SCC's were located in head and neck, eventually this may be derived from the surgeons excising lesions with a narrow border so as not to have poorly esthetic and functional results. Excision border of non melanoma skin cancers in head and neck must not be narrowed due to esthetic and functional concerns. As a result, regular follow up of skin cancered patients reduce the incidance of a new skin cancer and early diagnose of recurrences. Furthermore, regular entries of national cancer recordings anc consciousness-raising of the society about the skin cancer symptoms and treatment modalities, great advances may be achieved in early diagnose and treatment of skin cancers.