A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia - 21/08/11

Doi : 10.1016/j.jaad.2004.08.016

Richard C. Nolan, MBBS ^a, Madelynn T.-L. Chan, MBBS ^b, Peter J. Heenan, MBBS, FRCPath, FRCPA ^c,^⁎
^a From the Department of Anatomical Pathology
^b University of Western Australia; Department of Immunology
^c Fremantle Hospital; and the Department of Rheumatology Royal Mineral Water Hospital, Bath

Reprint requests: Peter J. Heenan, MBBS, FRCPath, FRCPA, Cutaneous Pathology, University of Western Australia, 26 Leura St, Nedlands, Perth, WA 6009.

Nedlands and Fremantle, Western Australia, and Bath, United Kingdom

Abstract

Background

Nonmelanoma skin cancer (NMSC) comprises a heterogeneous group of cancers. A comprehensive review of NMSC mortality has not been performed previously in this region.

Objective

We sought to document the population affected by lethal NMSC, the types of tumors involved, and their histopathologic features.

Methods

Death certificates of all patients who died from NMSC were examined. Histology of the primary lesion was reviewed in cases when the primary lesion was identified and sections were available.

Results

A total of 120 NMSC deaths occurred, including 89 caused by squamous cell carcinoma, 22 by Merkel cell carcinoma, and 9 others. The median age at death was 79 years, unless the patients were immune deficient (68 years). When the primary lesion was identified (n=45), the median survival after diagnosis was 17 months; 75% of patients died within 3 years. Lethal neoplasms were deeply invasive and infiltrated into the reticular dermis and beyond. Three squamous cell carcinomas were reclassified as adenosquamous carcinoma.