Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Melanom Dışı Deri Kanserlerinin Klinik, Histopatolojik ve Laboratuvar Özellikleri: 483 Hastanın Değerlendirildiği Retrospektif Tek Merkezli Bir Çalışma
Clinical, Histopathological and Laboratory Characteristics of Non-melanoma Skin Cancers: A Retrospective, Single-Center Study of 483 Patients
Yıldız HAYRANa, Pınar İNCEL UYSALa, Ahmet Uğur ATILANa, Hatice Pelin DEMİREL BULUTa, Güneş GÜR AKSOYa, Başak YALÇINa
aAnkara Numune Eğitim ve Araştırma Hastanesi, Deri ve Zührevi Hastalıkları Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2020;40(1):26-36
doi: 10.5336/medsci.2019-70678
Article Language: TR
Full Text
ÖZET
 Amaç: Melanom dışı deri kanserleri (MDDK) en sık görülen kanserlerdendir. Sıklığı ve hastalık özellikleri yaş, cinsiyet, deri fototipi ve coğrafi bölgelere göre değişiklik göstermektedir. Bu çalışmada, MDDK tanısıyla takip edilen hastaların demografik, klinik ve laboratuar bulgularının incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Mayıs 2014-Mayıs 2018 tarihleri arasında, dermatoloji kliniğinde MDDK tanısıyla takip edilen 483 hasta geriye dönük olarak incelendi. Hastaların demografik özellikleri, laboratuvar parametreleri ve MDDK'ya ait tümör ile ilişkili özellikleri kaydedildi. Bulgular: Çalışmaya dâhil edilen hastaların %37,7'si kadın, %62,3'ü erkekti. Yaş ortalaması 66,9 (±13,4) yıl olarak hesaplandı. Hastaların %57,1'i bazal hücreli karsinom (BHK), %42,9'u ise skuamöz hücreli karsinom (SHK) tanısıyla takipliydi. SHK'li hastalarda, BHK ile karşılaştırıldığında nötrofil lenfosit oranı (NLO) nın daha yüksek olduğu tespit edildi (0,044). SHK'li hastalarda ayrıca ülserasyon daha az oranda görülürken, gövde ve ekstremite tutulumunun daha sık olduğu tespit edildi (p değerleri sırasıyla <0,001 ve <0,001). Histopatolojik olarak agresif MDDK'ler tüm MDDK'lerin %37,4'ünü oluşturmaktaydı. Tam kan parametrelerinden Trombosit Dağılım Genişliği [Platelet Distribution Width (PDW)]'nin agresif MDDK'lerde daha yüksek seviyelerde olduğu görüldü (p=0,019). Agresif MDDK riski ile ilişkili faktörlerin incelendiği lojistik regresyon analizinde rekürren MDDK'lerin, lokalizasyon olarak baş-boyun bölgesinde yerleşen MDDK'lerin ve PDW düzeyleri yüksek hastaların histopatolojik olarak agresif MDDK olma ihtimalinin artmış olduğu gösterilmiştir (sırasıyla OR: 2,8; %95 güven aralığı: 1,1- 7,2; p=0,008; OR: 5,1; %95 güven aralığı: 1,1-23,3; p=0,036; OR: 1,2; %95 güven aralığı: 1,03-1,3; p=0,019). Sonuç: SHK'leri BHK'den ve agresif formları agresif olmayan alt tiplerden ayıran özelliklerin belirlenmesi, ileri tanı ve tedavi seçeneklerinin değerlendirilmesinde klinisyene yol gösterici olabilir.

Anahtar Kelimeler: Deri; kanser; risk
ABSTRACT
 Objective: Non-melanoma skin cancer (NMSC) is one of the most prevalent types of cancer. Prevalence and disease characteristics of NMSC widely vary with age, sex, skin phototype and geographical regions. The purpose of our study was to evaluate the demographic, clinical and laboratory characteristics of patients with NMSC. Material and Methods: Four hundred and eighty-three patients diagnosed with NMSC between May 2014 and May 2018 were retrospectively examined. Demographic characteristics and laboratory parameters of the patients as well as tumor associated features were recorded. Results: Thirty-seven point seven percent of the patients were female and 62.3% were male. Mean age of the patients was calculated as 66.9 (±13.4) years. Fifty-seven point one percent of the patients were followed up with the diagnosis of basal cell carcinoma (BCC) and 42.9% with the diagnosis of squamous cell carcinoma (SCC). Compared to BCC, patients with SCC had higher neutrophil to lymphocyte ratios (NLR) (p=0.044). Additionally had lower ulceration rates and more frequent extremity and truncal involvement (both p <0.001). Histopathologically aggressive NMSCs made up 37.4% of all NMSCs. Patients with aggressive NMSCs had higher Platelet Distribution Width (PDW) levels (p=0.019). Multivariate logistic regression analysis showed that recurrent NMSCs, NMSCs localized in the head-neck region and patients with high PDW levels had an increased risk of histopathologically aggressive NMSC (OR: 2.8; 95% CI: 1.1-7.2; p=0.008; OR: 5.1; 95% CI: 1.1-23.3; p=0.036; OR: 1.2; 95% CI: 1.03- 1.3; p=0.019, respectively). Conclusion: Identification of risk factors for aggressive NMSCs may help the clinician evaluate further diagnostic and therapeutic option.

Keywords: Skin; cancer; risk
REFERENCES:
  1. Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-80. [Crossref]  [PubMed] 
  2. Oh CM, Cho H, Won YJ, Kong HJ, Roh YH, Jeong KH, et al. Nationwide trends in the incidence of melanoma and non-melanoma skin cancers from 1999 to 2014 in South Korea. Cancer Res Treat. 2018;50(3):729-37. [Crossref]  [PubMed]  [PMC] 
  3. Devine C, Srinivasan B, Sayan A, Ilankovan V. Epidemiology of basal cell carcinoma: a 10-year comparative study. Br J Oral Maxillofac Surg. 2018;56(2):101-6. [Crossref]  [PubMed] 
  4. Emiroğlu N, Cengiz FP. [Retrospective analysis of non-melanoma skin cancer in Kütahya Tavşanlı Region]. Turkiye Klinikleri J Dermatol. 2015;25(2):39-44. [Crossref] 
  5. Duarte AF, Sousa-Pinto B, Freitas A, Delgado L, Costa-Pereira A, Correia O. Skin cancer healthcare impact: a nation-wide assessment of an administrative database. Cancer Epidemiol. 2018;56:154-60. [Crossref]  [PubMed] 
  6. Pondicherry A, Martin R, Meredith I, Rolfe J, Emanuel P, Elwood M. The burden of non-melanoma skin cancers in Auckland, New Zealand. Australas J Dermatol. 2018;59(3):210-3. [Crossref]  [PubMed] 
  7. Rubió-Casadevall J, Hernandez-Pujol AM, Ferreira-Santos MC, Morey-Esteve G, Vilardell L, Osca-Gelis G, et al. Trends in incidence and survival analysis in non-melanoma skin cancer from 1994 to 2012 in Girona, Spain: a population-based study. Cancer Epidemiol. 2016;45:6-10. [Crossref]  [PubMed] 
  8. Nguyen-Nielsen M, Wang L, Pedersen L, Olesen AB, Hou J, Mackey H, et al. The incidence of metastatic basal cell carcinoma (mBCC) in Denmark, 1997-2010. Eur J Dermatol. 2015;25(5):463-8. [Crossref]  [PubMed] 
  9. Di Stefani A, Chimenti S. Basal cell carcinoma: clinical and pathological features. G Ital Dermatol Venereol. 2015;150(4):385-91.
  10. Burton KA, Ashack KA, Khachemoune A. Cutaneous squamous cell carcinoma: a review of high-risk and metastatic disease. Am J Clin Dermatol. 2016;17(5):491-508. [Crossref]  [PubMed] 
  11. Micali G, Lacarrubba F, Bhatt K, Nasca MR. Medical approaches to non-melanoma skin cancer. Expert Rev Anticancer Ther. 2013;13(12):1409-21. [Crossref]  [PubMed] 
  12. Newlands C, Currie R, Memon A, Whitaker S, Woolford T. Non-melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S125-32. [Crossref]  [PubMed]  [PMC] 
  13. Fahradyan A, Howell AC, Wolfswinkel EM, Tsuha M, Sheth P, Wong AK. Updates on the management of non-melanoma skin cancer (NMSC). Healthcare (Basel). 2017;5(4):E82. [Crossref]  [PubMed]  [PMC] 
  14. Garg AD, Agostinis P. Cell death and immunity in cancer: from danger signals to mimicry of pathogen defense responses. Immunol Rev. 2017;280(1):126-48. [Crossref]  [PubMed] 
  15. Treffers LW, Hiemstra IH, Kuijpers TW, van den Berg TK, Matlung HL. Neutrophils in cancer. Immunol Rev. 2016;273(1):312-28. [Crossref]  [PubMed] 
  16. Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review. J Surg Oncol. 2017;115(4):470-9. [Crossref]  [PubMed] 
  17. Ethier JL, Desautels D, Templeton A, Shah PS, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res. 2017;19(1):2. [Crossref]  [PubMed]  [PMC] 
  18. Capone M, Giannarelli D, Mallardo D, Madonna G, Festino L, Grimaldi AM, et al. Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab. J Immunother Cancer. 2018;6(1):74. [Crossref]  [PubMed]  [PMC] 
  19. Ameratunga M, Chénard-Poirier M, Moreno Candilejo I, Pedregal M, Lui A, Dolling D et al. Neutrophil-lymphocyte ratio kinetics in patients with advanced solid tumours on phase I trials of PD-1/PD-L1 inhibitors. Eur J Cancer. 2018;89:56-63. [Crossref]  [PubMed] 
  20. Huang Y, Cui MM, Huang YX, Fu S, Zhang X, Guo H, et al. Preoperative platelet distribution width predicts breast cancer survival. Cancer Biomark. 2018;23(2):205-11. [Crossref]  [PubMed] 
  21. Yu YJ, Li N, Yun ZY, Niu Y, Xu JJ, Liu ZP, et al. Preoperative mean platelet volume and platelet distribution associated with thyroid cancer. Neoplasma. 2017;64(4):594-8. [Crossref]  [PubMed] 
  22. Xia W, Chen W, Tu J, Ni C, Meng K. Prognostic value and clinicopathologic features of platelet distribution with in cancer: a meta-analysis. Med Sci Monit. 2018;24:7130-6. [Crossref]  [PubMed]  [PMC] 
  23. Sexton M, Jones DB, Maloney ME. Histologic pattern analysis of basal cell carcinoma. Study of a series of 1039 consecutive neoplasms. J Am Acad Dermatol. 1990;23(6 Pt 1):1118-26. [Crossref] 
  24. Saldanha G, Fletcher A, Slater DN. Basal cell carcinoma: a dermatopathological and molecular biological update. Br J Dermatol. 2003;148(2):195-202. [Crossref]  [PubMed] 
  25. Harris RB, Griffith K, Moon TE. Trends in the incidence of nonmelanoma skin cancers in southeastern Arizona, 1985-1996. J Am Acad Dermatol. 2001;45(4):528-36. [Crossref]  [PubMed] 
  26. Muzic JG, Schmitt AR, Wright AC, Alniemi DT, Zubair AS, Olazagasti Lourido JM, et al. Incidence and trends of basal cell carcinoma and cutaneous squamous cell carcinoma: a population-based study in Olmsted County, Minnesota, 2000 to 2010. Mayo Clin Proc. 2017;92(6):890-8. [Crossref]  [PubMed]  [PMC] 
  27. Ceylan C, Oztürk G, Alper S. Non-melanoma skin cancers between the years of 1990 and 1999 in Izmir, Turkey: demographic and clinicopathological characteristics. J Dermatol. 2003;30(2):123-31. [Crossref]  [PubMed] 
  28. Chahal HS, Rieger KE, Sarin KY. Incidence ratio of basal cell carcinoma to squamous cell carcinoma equalizes with age. J Am Acad Dermatol. 2017;76(2):353-4. [Crossref]  [PubMed] 
  29. Sinz C, Tschandl P, Rosendahl C, Akay BN, Argenziano G, Blum A, et al. Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin. J Am Acad Dermatol. 2017;77(6):1100-9. [Crossref]  [PubMed] 
  30. Dinnes J, Deeks JJ, Chuchu N, Matin RN, Wong KY, Aldridge RB, et al; Cochrane Skin Cancer Diagnostic Test Accuracy Group. Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults. Cochrane Database Syst Rev. 2018;12:CD011901. [Crossref]  [PMC] 
  31. Huang Y, Sun Y, Peng P, Zhu S, Sun W, Zhang P. Prognostic and clinicopathologic significance of neutrophil-to-lymphocyte ratio in esophageal squamous cell carcinoma: evidence from a meta-analysis. Onco Targets Ther. 2017;10:1165-72. [Crossref]  [PubMed]  [PMC] 
  32. Lo WC, Wu CT, Wang CP, Yang TL, Lou PJ, Ko JY, et al. The pretreatment neutrophil-to-lymphocyte ratio is a prognostic determinant of T3-4 hypopharyngeal squamous cell carcinoma. Ann Surg Oncol. 2017;24(7):1980-8. [Crossref]  [PubMed] 
  33. Mizunuma M, Yokoyama Y, Futagami M, Aoki M, Takai Y, Mizunuma H. The pretreatment neutrophil-to-lymphocyte ratio predicts therapeutic response to radiation therapy and concurrent chemoradiation therapy in uterine cervical cancer. Int J Clin Oncol. 2015;20(5):989-96. [Crossref]  [PubMed] 
  34. Sebastian N, Wu T, Bazan J, Driscoll E, Willers H, Yegya-Raman N, et al. Pre-treatment neutrophil-lymphocyte ratio is associated with overall mortality in localized non-small cell lung cancer treated with stereotactic body radiotherapy. Radiother Oncol. 2019;134:151-7. [Crossref]  [PubMed] 
  35. Baykan H, Cihan YB, Ozyurt K. Roles of white blood cells and subtypes as inflammatory markers in skin cancer. Asian Pac J Cancer Prev. 2015;16(6):2303-6. [Crossref]  [PubMed] 
  36. Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Vakirlis E, Trakatelli M, et al. Farmers develop more aggressive histologic subtypes of basal cell carcinoma. Experience from a Tertiary Hospital in Northern Greece. J Eur Acad Dermatol Venereol. 2016;30(Suppl 3):17-20. [Crossref]  [PubMed] 
  37. Rivers JK, Mistry BD, Hung T, Vostretsova K, Mistry N. A 13-year retrospective study of basal cell carcinoma in a Canadian Dermatology Practice: a comparison between anatomical location and histopathologic subtypes. J Cutan Med Surg. 2016;20(3):233-40. [Crossref]  [PubMed] 
  38. Brougham ND, Dennett ER, Cameron R, Tan ST. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. J Surg Oncol. 2012;106(7):811-5. [Crossref]  [PubMed] 
  39. Brinkman JN, Hajder E, van der Holt B, Den Bakker MA, Hovius SE, Mureau MA. The effect of differentiation grade of cutaneous squamous cell carcinoma on excision margins, local recurrence, metastasis, and patient survival: a retrospective follow-up study. Ann Plast Surg. 2015;75(3):323-6. [Crossref]  [PubMed] 
  40. Lallas A, Pyne J, Kyrgidis A, Andreani S, Argenziano G, Cavaller A, et al. The clinical and dermoscopic features of invasive cutaneous squamous cell carcinoma depend on the histopathological grade of differentiation. Br J Dermatol. 2015;172(5):1308-15. [Crossref]  [PubMed] 
  41. Yalcin O, Sezer E, Kabukcuoglu F, Kilic AI, Sari AG, Cerman AA, et al. Presence of ulceration, but not high risk zone location, correlates with unfavorable histopathological subtype in facial basal cell carcinoma. Int J Clin Exp Pathol. 2015;8(11):15448-53.
  42. Zuo X, Kong W, Feng L, Zhang H, Meng X, Chen W. Elevated platelet distribution width predicts poor prognosis in hepatocellular carcinoma. Cancer Biomark. 2019;24(3):307-13. [Crossref]  [PubMed] 
  43. Fu S, Zhang X, Niu Y, Wang RT. Prostate specific antigen, mean platelet volume, and platelet distribution width in combination to discriminate prostate cancer from benign prostate hyperplasia. Asian Pac J Cancer Prev. 2018;19(3):699-702.
  44. Li N, Diao Z, Huang X, Niu Y, Liu T, Liu ZP, et al. Increased platelet distribution width predicts poor prognosis in melanoma patients. Sci Rep. 2017;7(1):2970. [Crossref]  [PubMed]  [PMC] 

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www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com