DermatopathologyA clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia
Section snippets
Patient selection
The WA state cancer registry records all cancer-related deaths in the state. Individuals are considered to have died from skin cancer when the diagnosis is listed as a cause of death on the death certificate. Further clarification is sought from the attending clinicians by the registry if doubt exists as to the role of a cancer in the patient's death. Incidence rates are collected for cutaneous malignant melanoma but not SCC or BCC.9
All patients classified as dying from biopsy-proven skin
Demographic characteristics
During the 5 years of 1994 to 1998, 120 patients died from NMSC based on WA cancer registry information. In the same period, 14,562 patients died from cancer in WA15; thus, 0.8% of all cancer deaths were caused by NMSC. The median age of death was 79 years, ranging from 46 to 101 years (Fig 1). Men were affected more commonly (n = 80) than women (n = 40). Cause of death was recorded on death certificates as: 89 SCC; 22 MCC; 6 sarcomas including two malignant fibrous histiocytomas, two
Discussion
This review documents the number of deaths from NMSC in WA during a 5-year period and describes macroscopic and histopathologic features of the primary neoplasms. During the study period, 0.8% of cancer-related deaths in WA were caused by NMSC, which were mainly of 3 types: SCC, MCC, and ASC. Importantly, both macroscopically small and large neoplasms have caused death whereas most neoplasms invaded deeply, suggesting that depth of invasion is a more accurate prognostic indicator than surface
Conclusion
NMSC deaths in WA are caused mainly by SCC, MCC, or ASC. Many of these neoplasms, especially MCC, are small but have invaded deeply at the time of excision and not all have the classic markers of a poor prognosis. Data generated from this and subsequent studies on larger numbers of lethal NMSC should assist pathologists and clinicians to recognize indicators of poor prognosis in NMSC.
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Conflicts of interest: None identified.