Skin cancers among adult patients attending the Ocean road cancer institute in Dar es salaam – prevalence, pattern, clinical presentation and factors associated with treatment outcomes

Abstract

ABSTRACT Background: Skin malignancies are a cause of significant morbidity and mortality globally, although they are generally under-reported in most parts of Africa. In Tanzania, a study conducted in 2018 reported commonest cancers to be Malignant Melanoma (65%), Kaposi’s sarcoma (10.4%), Squamous cell carcinoma (8.4%) and basal cell carcinoma (7.8%). Other non-melanoma skin cancers are not well documented. With the ongoing efforts to prevent and improve care for patients with skin cancers in the country, not much is known about the current pattern, clinical presentation, outcomes of treatment, and the factors associated with such outcomes. Objectives: To describe the prevalence, pattern, clinical presentation, treatment modalities offered, outcomes of treatment offered and factors associated with outcomes of treatment among patients presenting with skin malignancies at the ORCI. Methodology: This was a hospital based retrospective cohort study which was carried out at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. Adult patients who were 18 years and above with a confirmed diagnosis of skin cancer attended from January 2019 to October 2023 were systematically selected from the hospital database and medical records to the desired sample size of 480. A structured Questionnaire was used for data entry. Descriptive statistics were used to summarize the data, while factors associated with outcome of treatment were analyzed initially using a univariate analysis, and then a multivariate analysis for variables with p-values < 0.2. Kaplan Meir curves were used to describe survival. A p-value less than 0.05 was regarded as statistically significant. Results: A total of 480 patients were enrolled. Kaposi's Sarcoma was the most prevalent cancer accounting for 57% of cases (95% CI: 53% - 62%). This was followed by Squamous Cell Carcinoma at 22% (95% CI: 18% - 26%). Kaposi’s Sarcoma predominantly manifested on the lower limbs (79.6%). Clinical presentation of the different skin cancer types varied according to the type of cancer. Kaposi’s Sarcoma iv presented with irregular multiple nodular lesions in (36%) of patients, lesions were commonly hyperpigmented (47.3%), and most had an irregular, nodulated surface (21.5%). Malignant Melanoma was characterized mostly by irregular and roundish lesions (39 % and 31.7% respectively), and most lesions were hyperpigmented (48.8%). The median duration between first symptom onset and definitive treatment initiation was 6 months. Prevalence of HIV among the patients was high (22.9%). The overall mortality was 11.3%, being higher (14.5%) among HIV positive patients. The overall one–year survival rate of patients with skin cancer at the ORCI was 90.7%. Patients with no education had significantly lower odds of being cured compared to those with other education levels (Odds Ratio of 0.1 [(95% CI = 0.01 - 0.88,0 p = 0.038]). Conclusion: During the study period, the most common skin cancer was Kaposi’s Sarcoma. There was high mortality among those who were HIV positive. Most patients received treatment rather late, but had good survival and patients treated by radiotherapy had better outcome. There is need for emphasis on formal educational for better treatment outcomes.