Acta Dermato-Venereologica 99-4CompleteContent | Page 14

412 CLINICAL REPORT Characteristics and Trends of Cutaneous Squamous Cell Carcinoma in a Patient Cohort in Finland 2006–2015 Niina KORHONEN 1 , Leea YLITALO 1,2 , Tiina LUUKKAALA 3 , Julius ITKONEN 1 , Henni HÄIHÄLÄ 1 , Juha JERNMAN 4 , Erna SNELLMAN 1 and Johanna PALVE 5 1 Department of Dermatology and Allergology and 5 Department of Plastic Surgery, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, 2 Department of Dermatology, Skin Cancer Unit, Helsinki University Central Hospital, Helsinki, 3 Research, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, and 4 Department of Pathology, University of Tampere and Fimlab Laboratories, Tampere, Finland The incidence of cutaneous squamous cell carcinoma is increasing worldwide. In most epidemiological studies, only the first case of cutaneous squamous cell carci- noma is registered, underestimating the burden of the disease. To determine the frequency and detailed cha- racteristics of cutaneous squamous cell carcinoma in a Finnish patient cohort, we performed a retrospective 10-year study taking into account multiple tumours in one patient. On the pathology database search and medical record review we identified 774 patients with a total of 1,131 cutaneous squamous cell carcinomas. The crude incidence increased from 18.6/100,000 per- sons in 2006 to 28.1 in 2015. The location of tumours differed between men and women: the greatest diffe- rence concerned cutaneous squamous cell carcinoma of the ear, with 93% of cases occurring in men. One fourth (24%) of patients had more than one tumour. A small shift from poorly to well-differentiated tumours was seen. In conclusion, the incidence of cutaneous squamous cell carcinoma increased, with many pa- tients presenting with multiple tumours. Key words: squamous cell carcinoma; keratinocyte carcinoma; non melanoma skin cancer; incidence; histopathology. Accepted Jan 7, 2019; E-published Jan 9, 2019 Acta Derm Venereol 2019; 99: 412–416. Corr: Niina Korhonen, Department of Dermatology and Allergology, Tam- pere University Hospital, Teiskontie 35, FIN-33521 Tampere, Finland. E- mail: [email protected] C Acta Derm Venereol 2019; 99: 412–416 Cutaneous squamous cell carcinoma is one of the most common cancers of the skin. A more precise and timely knowledge of these tumours is needed in order to provide optimal care. This study describes the epidemiology of cu- taneous squamous cell carcinomas in a patient cohort in Finland, analysing the anatomical distribution, histopatho- logical features and treatment modalities to reflect the ty- pical day-to-day clinical practice. dies, only the first case of cSCC in a patient is registered while subsequent and multiple tumours are not taken into account (4). For future planning, a more precise and timely knowledge of cSCC epidemiology and tumour characteristics is needed for optimal patient care (7). We carried out a retrospective 10-year study to deter- mine the frequency and characteristics of all detected and treated cSCCs in a Finnish regional university hospital cohort. Finland is a Nordic country with approximately 5,5 million inhabitants of whom 30% have Fitzpatrick’s skin phototypes I or II and 60% type III (9). We have analysed the anatomical distribution, histopathological features and treatment modalities to reflect typical day- to-day clinical practice in patients with cSCC, including those with multiple tumours. METHODS utaneous squamous cell carcinoma (cSCC) is one of the most common cancers of the skin. Although rarely fatal (1), cSCC reduces the quality of life of pa- tients through functional impairment and severe cosmetic and psychosocial sequelae (2, 3). The incidence of cSCC is increasing in white populations worldwide (4). Thus, cSCCs have a substantial and increasing impact on healthcare costs (5). Most cSCCs occur in people aged 60 years or older (6), a population expanding rapidly in aging societies in the near future. Consequently, cSCCs are creating an increasing demand on healthcare systems due to restricted resources (5, 7). Although the burden of disease caused by cSCC is known to increase, the available registry data on cSCC epidemiology may still underestimate its impact on the healthcare systems (4, 8). In most epidemiological stu- doi: 10.2340/00015555-3110 SIGNIFICANCE The pathology database of Fimlab Laboratories was searched for the histopathologic diagnosis of ‘cutaneous squamous cell carci- noma’ between 1 January 2006 and 31 December 2015. Fimlab provides the laboratory services in Pirkanmaa region of Finland, meaning that all patients with a cSCC diagnosis in the region were identified. In situ cSCC were excluded. We reviewed the clinical records of Tampere University Hospital, which is the region’s largest hospital and the tertiary referral centre of Pirkanmaa, for all identified cSCC patients. Data regarding demographic factors, including patient age at diagnosis of the primary tumour, sex and associated diseases, particularly immunosuppression, were registered. If the clinical notes indicated that the patient had cSCC before year 2006, this was registered. Features of the tumours including the anatomic localisation, differentiation and depth of invasion were obtained. Degree of differentiation was classified either as well, moderate or poorly. Diagnostic duplicates, i.e. tumours first biopsied and then (re-) excised, were taken into account and reassessed to identify the actual number of primary cSCCs. Patients with multiple primary This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.