Squamous cell carcinoma of the skin: clinical pattern and challenges of treatment

In Nigeria, Tanzania and Togo, squamous cell carcinoma (SCC) is the commonest skin malignancy. This is in contrast with the Caucasians in Europe, North America and Australia where basal cell carcinoma accounts for 70– 80% of skin cancer. Risk factors vary with race, geographic region and site of lesion. We present this study to highlight the clinical pattern, risk factors, challenges and outcome of management of this problem in our region. All patients with histologic diagnosis of squamous cell carcinoma that presented to the University of Calabar Teaching Hospital, Calabar from January 2005 to December 2009 were studied. In total, 38 patients (18 males, 20 females) whose ages ranged from 16 to 70 years (mean 44.8 years) were afflicted with SCC lesions. They accounted for 39.0% of skin malignancy and 5.7% of total malignancy. Kaposi sarcoma 33 (33%) ranked second while malignant melanoma 11 (11%) was third. The ages of the eight albinos (four males, four females) recorded ranged between 21 and 30 years (mean 24.3 years). The ages of the 30 blacks (14 males, 16 females) ranged from 16 to 70 years (mean 50.2 years). The lower limb was the commonest afflicted site recorded in 15 (39.0%) patients. The head and neck ranked second with 14 (37.0%) patients while the anogenital region with eight (21%) patients ranked third. Marjolin’s ulcer recorded in 14 (36.8%) patients afflicted only the limbs. The results were satisfactory in 13 (34%) patients, while in 21 (55%) patients, the outcome was poor, and hospital mortality was recorded in four (11%) patients. Squamous cell carcinoma is largely preventable, late presentation with advanced lesion was a major underlying issue. Early institution of preventive strategies, early presentation and proper surgical evaluation of chronic ulcers would improve outcome.