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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 75-78

Histopathological review of dermatological malignancies in Makurdi, North Central Nigeria


1 Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi, Nigeria
2 Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria
3 Department of Morbid Anatomy, College of Heath Sciences, Bingham University, Jos, Nigeria
4 Department of Medicine, College of Health Sciences, Benue State University, Makurdi, Nigeria

Date of Web Publication11-Jun-2018

Correspondence Address:
Dr. Joseph Aondowase Ngbea
Department of Anatomical Pathology, College of Health Sciences, Benue State University, Makurdi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atp.atp_12_18

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  Abstract 

Objective: Dermatological malignancies are among the common forms of cancer worldwide, especially Caucasians, and are noted to be in the skins of Africans and Negroid. The study aims to determine the frequency and patterns of dermatological malignancies in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria. Methods: This was a 5-year retrospective study of skin samples seen at the Department of Anatomical Pathology, BSUTH, Makurdi, between March 2012 and February 2017. Results: A total of 215 skin biopsies were seen at the department during the study. Of these, 151 cases were dermatological malignancies constituting 70.2% of all skin lesions. Majority of these malignancies occurred between the fourth and fifth decades with a male-to-female ratio of 1.4:1. Kaposi sarcoma (KS) was the most common dermatological malignancy (n = 78; 52%). Squamous cell carcinoma constituted second majority (n = 30, 20%), followed by malignant melanoma (n = 22.1, 14.7%), dermatofi brosarcoma protuberans (n = 17, 11.3%), and basal cell carcinoma (n = 9, 6%). Leg, foot, and forearm were the common sites affected. Conclusion: KS was the most common dermatological malignancy in the study. Nearly all patients were HIV/AIDS positive. The findings in this study are similar to those from other parts of Africa and Nigeria. Therefore, HIV/AIDS control can substantially reduce the incidence, morbidity, and mortality of KS.

Keywords: Dermatological malignancies, Kaposi sarcoma, Makurdi


How to cite this article:
Ngbea JA, Vhriterhire AR, Akpor IO, Terhemba N, Ugbaje BA, Ojo BA, Gyenger DT, Ahachi CN, Jegede OO, Echekwube PO. Histopathological review of dermatological malignancies in Makurdi, North Central Nigeria. Ann Trop Pathol 2018;9:75-8

How to cite this URL:
Ngbea JA, Vhriterhire AR, Akpor IO, Terhemba N, Ugbaje BA, Ojo BA, Gyenger DT, Ahachi CN, Jegede OO, Echekwube PO. Histopathological review of dermatological malignancies in Makurdi, North Central Nigeria. Ann Trop Pathol [serial online] 2018 [cited 2019 Sep 21];9:75-8. Available from: http://www.atpjournal.org/text.asp?2018/9/1/75/234143


  Introduction Top


Dermatological malignancies are the most common disorders worldwide.[1],[2] In the white population, the incidence is on the increase but lower among the dark-pigmented people of developing countries of the world.[3] The major reason for this racial difference in the distribution of skin cancer is the protection from ultraviolet (UV) radiation provided by melanin in the dark-pigmented races.[4] The skin happens to be the largest organ in the body and is composed of many types of cells and is in contact directly or indirectly with a lot of carcinogens such as UV radiation and chemical carcinogens.[5],[6] Sun exposure is the major risk factor in white people, albinism and immune suppression are risk factors of some skin cancers in black Africans.[7] This study is aimed at defining the frequency and morphological patterns of dermatological malignancies in Benue State University Teaching Hospital (BSUTH). Data derived from this study would be useful in the management of these lesions and moreover serve as baseline data for further research.

Studies done within and outside Nigeria have documented the preponderance of Kaposi sarcoma (KS) as the most common dermatological malignancy in some parts of the world. In Europe, North America, and Australia, KS accounts for over 50% of all skin malignancies, especially in sunny tropical climates.[6] The findings in our study are higher than studies in other parts of Nigeria.[6],[8]

BSUTH, Makurdi, is one of the tertiary health centers offering histopathology services in Benue state with an estimated population of 8 million people.

This study examines the frequency and pattern of dermatological malignancy in Makurdi and compares them with those in the general population and other parts of the world.


  Methods Top


This is a 5-year (March 2012 to February 2017 inclusive)descriptive, retrospective study of 215 histologically diagnosed skin specimens received at the Department of Anatomical Pathology, BSUTH, Makurdi.

All specimens were fixed in 10% formalin solution, processed, and stained with hematoxylin and eosin. The results obtained were analyzed with respect to age, sex, and type of tumor. Data analysis was performed using the Statistical Package for the Social Sciences version 16 (SPSS Inc., South Wacker Drive, Chicago, Illinois, USA).


  Results Top


During the 5-year study, 215 skin specimens were received at the Department of Anatomical Pathology, BSUTH, Makurdi. Of these, 151 specimens were dermatological malignancies.

KS thus accounted for 78 (52%) of cases while squamous cell carcinoma (SCC) constituted the second majority with 20%. Malignant melanoma ranked third at 22 (14.7%) of cases. Dermatofi brosarcoma protuberance comprised 12 (11.3%) patients and ranked fourth; basal cell carcinoma (BCC) (9, 6%) was the last.


  Discussion Top


Dermatological malignancies accounted for 43% of all histopathologically diagnosed skin lesions seen during the studied [Table 1]. This figure is comparable to Caucasian studies in Europe, North America, and Australia, where skin cancer accounts for over half (>50%) of all malignancies, especially those living in sunny tropical climates.[6] Our prevalence is higher than studies in other parts of Nigeria, 6.18% in Jos, but lower than 10% in Calabar, 14% in Lagos, 12.4% in Zaria, and 12.7% in Kano. The higher prevalence in Zaria and Kano may be explained by high environmental temperature and low humidity in these cities.[8]
Table 1: Histopathological pattern of skin biopsies in Benue State University Teaching Hospital (March 2012-February 2017)

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KS (78, 51.7%) is the most common dermatological malignancy in our center followed by SCC (30, 19.9%) [Table 1] and [Table 2]. This is in contrast with the reports from the United States and other Western world countries which favor BCC as the most common dermatological cancer.[9] The prevalence of KS in Makurdi, Benue State, Nigeria, is generally on the increase [Table 3]. This is partly attributed to the increased prevalence and incidence of HIV/AIDS-associated KS in Nigeria, Sub-Saharan Africa, and all over the world.[10] High incidence of dermatological malignancies in Caucasian population has been attributed to the lower levels of oncoprotective skin melanin which renders them more vulnerable to carcinogenic solar UV radiation and ozone layer depletion which filters UV radiation.[11]
Table 2: Histopathological types of dermatological malignancies (n=151)

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Table 3: The proportion of histological subtypes of dermatological malignancies from various sites of the body (n=151)

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This study has shown that KS is more often seen in HIV/AIDS patients. Many accumulated evidence indicates that human herpesvirus type 8 is an important cofactor in the pathogenesis of AIDS-associated KS. The virus is reported to be present in >90% of KS lesions.[12] The virus releases cytokines as well as HIV tat protein which contribute to the pathogenesis of KS. Contrary to the fact that KS is seen exclusively in men, we found AIDS-associated KS affecting both sexes and with female preponderance [Table 1] and [Table 2].

AIDS-associated KS can affect any area of the skin [Figure 1] and [Figure 2] as well as the genitourinary area; the most common site in this study was the lower limb, upper limb, trunk, head and neck, and perineum [Table 3]. Involvement of multiple sites was noticed in some patients.[13]
Figure 1: Clinical photograph of Kaposi's sarcoma in a HIV/AIDS patient showing generalized fungating skin nodules over the hand

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Figure 2: Section of the skin shows a stratified squamous epithelium with a fibrocollagenous stroma within which are seen proliferating plumped spindle cells lined by slit-like vascular channels (H and E, ×20)

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KS can present at any time in HIV infection and generally occurs at CD4 count <200 cell/mm 3 and viral load of >10,000 log RNA copies/ul.[14]

SCC was the second most prevalent malignancy in our locality comprising 10% of skin cancer [Table 2], which is in contrast to a previous study in Tanzania and other African countries that reported SCC as the most common dermatological malignancy as reported by Amir et al., Yakubu and Mabogunje, Adayi and Banjo, Mandong et al., and Diepgen and Mahler.[15] Many of these studies reported SCC arising from chronic ulcers as a major risk factor.[16] Our finding is in agreement with these findings where about 60% of SCC arose from chronic ulcers from the lower limbs [Table 2].

In general, SCC is the second most common nonmelanoma skin cancer (NMSC) preceded in frequency by BCC. It originates from epidermal keratinocytes or adnexal structures of eccrine glands or pilosebaceous units.[17]

Conventionally, skin cancers have been divided into two major groups: melanoma and NMSC.

SCC is estimated to have a lifetime incidence of 7%–11% in the USA, whereas that of BCC is 28%–33%.[17] In the USA, the average age of onset is the mid-sixth decade, but individual may be as young as 20–30 years of age. The disease has predilection for males, but the incidence of SCC originating on the leg is greater in females. In this study, more males were affected than females [Table 2].

Factors that increase the risk for SCC include UV radiation, lightly pigmented people, exposure to herpes simplex virus types 16, 18, and patients treated with psoralen and UV A for psoriasis.[18]

Other factors include actinic keratosis in transplant recipient patients, possession of human leukocyte antigen, immunosuppressive agents, and inherited conditions such as albinism and xeroderma pigmentation.[19]


  Conclusion Top


Dermatological malignancies, especially KS, are more prevalent in our setting; HIV/AIDS, chronic ulcer, albinism, and burn scars are associated risk factors; and surgeons should always biopsy all suspected lesions.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ahachi CN, Akaa PD, Elach IC, Mue DD, Ngbea JA, Anakebe IN, et al. Clinico-pathologic characteristics of skin cancer at Benue State University Makurdi, Nigeria. J Plast Surg 2016;12:56-61.  Back to cited text no. 1
    
2.
Forae GD, Olu-Eddo AN. Malignant skin tumour in Benin City. Oman Med J 2013;28:311-5.  Back to cited text no. 2
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3.
Ochicha O, Edino ST, Mohammed AZ, Umar AB. Dermatological malignancies in Kano, Northern Nigeria: A histopathological review. Ann Afr Med 2004;3:188-91.  Back to cited text no. 3
    
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Asuquo ME, Ebughe G. Major dermatological malignancies encountered in UCTH Calabar, Southern Nigeria. Int J Dermatol 2012;51:32-6.  Back to cited text no. 4
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5.
Ngbea JA, Mandong BM, Ayuba MD, Miner CA, Jegede OO, Vhriterhire RA. Histopathological patterns of skin manifestations of HIV/AIDS in Jos. Int J Health Sci Int 2015;5:145-54.  Back to cited text no. 5
    
6.
Oseni GO, Olaitan PB, Komolafe AO, Olaofe OO, Akinyemi HA, Suleiman OA, et al. Malignant skin lesions in Oshogbo, Nigeria. Pan Afr Med J 2015;20:253.  Back to cited text no. 6
    
7.
Asuquo ME, Ngim O, Ebughe G, Bassey EE. Skin cancers amongst four Nigerian albinos. Int J Dermatol 2009;48:636-8.  Back to cited text no. 7
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8.
Chalya PL, Gilyoma JM, Kanumba ES, Mawala B, Masalu N, Kahima KJ, et al. Dermatological malignancies at a university teaching hospital in North-Western Tanzania: A retrospective review of 154 cases. Tanzan J Health Res 2012;14:9-14.  Back to cited text no. 8
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9.
Ngbea JA, Dzuachii OD, Agada E, Orkuma JA, Miner CA, Akaa PD, et al. Histopathological pattern of HIV/AIDS related Kaposis's sarcoma in Jos, North Central Nigeria. J Med Sci 2015;14:102-4.  Back to cited text no. 9
    
10.
Mandong BM, Chirdan LB, Anyebe AO, Manasseh AN. Histopathological study of Kaposis sarcoma in Jos. Ann Afr Med 2004;3:170-6.  Back to cited text no. 10
    
11.
Forae G, Adesuwa NO. Malignant skin tumours in Benn city, South Nigeria. Oman Med J 2013;28:311-5.  Back to cited text no. 11
    
12.
Tembo R, Kaile T, Kafita D, Chisanga C, Kalonda A, Zulu E, et al. Detection of human herpes virus and Kaposi's sarcoma tissues at the university teaching hospital, Lusaka, Zambia. Pan Afr Med J 2017;27:137.  Back to cited text no. 12
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13.
Sullivan RJ, Pantanowitz L, Casper C, Stebbing J, Dezube BJ. HIV/AIDS: Epidemiology, pathophysiology, and treatment of Kaposi sarcoma-associated herpesvirus disease: Kaposi sarcoma, primary effusion lymphoma, and multicentric castleman disease. Clin Infect Dis 2008;47:1209-15.  Back to cited text no. 13
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14.
Ahmed A, Muktar HM, Bugaje MA. Epidemiology and clinical features of AIDS-associated Kaposi sarcoma in Northern Nigeria. Arch Int Surg 2013;3:29-34.  Back to cited text no. 14
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15.
Diepgem TL, Mahler V. The epidemology of skin cancer. Dematol Br J 2002;61 Suppl:1-6.  Back to cited text no. 15
    
16.
Mandong BM, Orkar KS, Sule AZ, Dakum NL. Malignant skin tumours In Jos University Teaching Hospital, Jos, Nigeria (hospital-based study). Niger J Surg Res 2000;3:29-33.  Back to cited text no. 16
    
17.
Adeyi O, Banjo AA. Malignant tumours of the skin a six year review of histologically diagnosed cases. Niger Q J Hosp Med 2000;2:99-102.  Back to cited text no. 17
    
18.
Kallini JR, Hamed N, Khachemoune A. Squamous cell carcinoma of the skin: Epidemiology, classification, management, and novel trends. Int J Dermatol 2015;54:130-40.  Back to cited text no. 18
    
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Asuquo ME, Ebughe G. Cutaneous cancers in calabar, Southern Nigeria. Dermatol Online J 2009;15:11.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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