Primary skin cancers represent a diverse group of malignancies arising from epithelial, hematopoietic, and mesenchymal tissues. In adults, non-melanoma skin cancers constitute the majority of cutaneous tumors, making up approximately 90% of cases [1,2]. Malignant melanoma is the second most common skin cancer, accounting for 5–10% of cases, followed by malignant lymphoproliferative disorders, cutaneous metastases, sarcomas, and, much less frequently, malignant adnexal tumors, Merkel cell carcinoma, and other rare neoplasms. Notably, the incidence and mortality of melanoma are rising in regions with predominantly light-skinned populations [3,4]. While the increase is slower among younger adults compared to older age groups, recent studies indicate an upward trend in both melanoma and non-melanoma skin cancers in younger individuals, particularly affecting women for melanoma and both sexes for non-melanoma tumors [2].

Despite the growing global burden of skin cancers, data from hospital-based studies in South Asia, including Bangladesh, are limited. Adult primary cutaneous malignancies exhibit diverse clinical manifestations and risk profiles; however, population-based studies and epidemiological descriptions, especially in younger adults, remain scarce [5]. This lack of systematic data hinders a comprehensive understanding of the distribution and determinants of skin cancers in the region.

Among identified risk factors, sun exposure is the most consistently reported exogenous contributor to cutaneous malignancies. The 1991 Consensus Development Conference on Sunlight, Ultraviolet Radiation, and the Skin recognized sun exposure as the only established external cause of melanoma in light-skinned populations. Similarly, the International Agency for Research on Cancer (IARC) affirmed that ultraviolet exposure is a primary causal factor for cutaneous melanoma [6,7]. Distinguishing the effects of sunburn, overall sun exposure patterns, tanning ability, and other phenotypic characteristics remains challenging. Ultraviolet radiation can act both as an initiator, such as through sunburn, and as a promoter, inducing naevi and potentially stimulating melanocytes that may not otherwise proliferate in early stages [8-10].

Despite the recognized global burden and established risk factors of cutaneous malignancies, there is a paucity of comprehensive hospital-based data from Bangladesh. Few studies have systematically evaluated the epidemiological patterns, anatomical distribution, and associated risk factors of different types of skin cancers in this population. In particular, the relative contributions of sun exposure, skin type, smoking, and family history remain underexplored, limiting the ability to inform targeted prevention and early detection strategies. Hence, this study aims to evaluate the distribution and associated risk factors of cutaneous malignancies in patients presenting to a tertiary care hospital.

Objective

• To assess the distribution and associated risk factors of cutaneous malignancies among patients attending a tertiary care hospital.

This retrospective, cross-sectional study was conducted at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from August 2009 to July 2010. A total of 120 patients with histopathologically confirmed cutaneous malignancies were included, selected based on the availability of complete clinical and histopathological records.

Inclusion Criteria:

• Patients with a histopathologically confirmed diagnosis of any primary cutaneous malignancy within the study period.

 Exclusion Criteria:

• Patients with incomplete medical records.
• Cases with premalignant conditions only (e.g., Bowen's disease, actinic keratosis).
• Metastatic deposits to the skin from a primary internal malignancy.

Demographic data (age, sex), clinical features (anatomical site and type of malignancy), and potential risk factors (chronic sun exposure, Fitzpatrick skin type, smoking history, and family history) were collected using a structured data extraction form. Cutaneous malignancies were categorized as Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), Malignant Melanoma (MM), and other rare types (including adnexal tumors and cutaneous lymphoma). Chronic sun exposure was defined as occupational or lifestyle-related exposure for ≥10 years, and Fitzpatrick skin type was assessed clinically (Type II, III, IV). Data were entered and analyzed using SPSS version 16.0, with descriptive statistics expressed as frequencies, percentages, and mean ± standard deviation (SD). Associations between risk factors and malignancy types were evaluated using the Chi-square (χ²) test, with p < 0.05 considered statistically significant.

Figure 1: Frequency of Cutaneous Malignancy Types among the Study Population (N = 120)

Figure 1 shows the distribution of histopathologically confirmed cutaneous malignancies among the study population. Basal Cell Carcinoma (BCC) was the most common type, accounting for 61 cases (50.8%), followed by Squamous Cell Carcinoma (SCC) with 50 cases (41.7%). Malignant Melanoma (MM) was relatively less frequent (7 cases, 5.8%), while other rare malignancies, including adnexal tumors and cutaneous lymphoma, accounted for 2 cases (1.7%).

Table 1: Demographic and Clinical Characteristics of the Study Population (N = 120)

Table 1 presents the demographic characteristics and anatomical distribution of cutaneous malignancies in the study population. The mean age of patients was 50.41 ± 11.51 years, with the highest frequency in the 50–59 year age group (46.7%), indicating that middle-aged and older adults were most commonly affected. Male patients (58.3%) outnumbered females (41.7%), showing a male predominance. Regarding anatomical distribution, the face was the most frequently involved site (41.7%), followed by the trunk (26.7%), scalp (15.0%), and limbs (16.7%).

Table 2: Distribution of Risk Factors among the Study Population (N = 120)

Among the study population, 55 patients (45.8%) reported chronic sun exposure, while 65 (54.2%) did not. With regard to skin type, the majority were Fitzpatrick type III (65 patients, 54.2%), followed by type IV (35 patients, 29.2%), and type II (20 patients, 16.7%). A history of smoking or ex-smoking was reported in 18 patients (15.0%), whereas 102 patients (85.0%) were non-smokers. Family history of cutaneous malignancy was present in 10 patients (8.3%), while the majority, 110 patients (91.7%), had no such history.

Table 3: Association of Risk Factors with Type of Cutaneous Malignancy (N = 120)

Table 3 illustrates the distribution of key risk factors across different types of cutaneous malignancies. Chronic sun exposure was significantly higher among patients with SCC (70.0%) and MM (57.1%) compared to BCC (24.6%) and other malignancies (50.0%), indicating its strong association with malignancy type (p < 0.001). Smoking history was most common in SCC patients (26.0%) but did not reach statistical significance (p = 0.08). Family history of cutaneous malignancy was infrequent across all groups and showed no significant association (p = 0.86). These findings highlight chronic sun exposure as the primary determinant among the evaluated risk factors in this cohort.

Distribution patterns and risk factors of cutaneous malignancies among patients attending a tertiary care hospital in Bangladesh. Cutaneous malignancies, a diverse group of skin cancers, pose significant challenges due to their potential for local tissue destruction, functional impairment, and, in some cases, metastasis. The findings highlight the predominance of basal cell carcinoma and squamous cell carcinoma, with contributing factors such as chronic sun exposure, skin type, and age playing key roles. The high prevalence of lesions in sun-exposed areas underscores the need for preventive measures, early detection, and public awareness to reduce disease burden and improve patient outcomes.

In the present study, Basal Cell Carcinoma (BCC) was the most frequently diagnosed cutaneous malignancy, accounting for 61 cases (50.8%), followed by Squamous Cell Carcinoma (SCC) with 50 cases (41.7%), Malignant Melanoma (MM) with 7 cases (5.8%), and other rare malignancies constituting 2 cases (1.7%). This pattern is largely consistent with the findings of Kennedy et al.[11], who also reported BCC as the predominant skin cancer, highlighting its global predominance among cutaneous malignancies. The higher frequency of BCC in both studies may be attributed to cumulative ultraviolet exposure and other environmental or occupational risk factors, which are known to preferentially affect sun-exposed areas. SCC, the second most common malignancy in our cohort, similarly reflects trends observed in other South Asian populations, where it often follows BCC in prevalence. Malignant melanoma, although less common, remains clinically significant due to its aggressive behavior, consistent with prior regional studies. The low proportion of other rare malignancies underscores the predominance of BCC and SCC in hospital-based cohorts, reinforcing the need for focused preventive strategies and early detection efforts targeting these major subtypes.

In the present study, the mean age of patients was 50.41 ± 11.51 years, with the highest frequency observed in the 50–59 year age group (46.7%), which is consistent with previous reports showing that cutaneous malignancies are most common in the fifth and sixth decades of life. A male predominance (58.3%) was also noted, comparable to Rajagopal et al.[12], who reported 52% male cases among 300 patients. In terms of anatomical distribution, the face was the most frequently involved site (41.7%), followed by the trunk (26.7%), scalp (15.0%), and limbs (16.7%). This distribution differs slightly from earlier studies [13,14], which often reported higher frequencies in the limbs and scalp. BCC mainly on the head and neck (80%), and MM largely on the lower extremities (66.7%). These variations may reflect differences in sun exposure patterns, occupational habits, and genetic predispositions across populations, underscoring the importance of context-specific epidemiological data for effective risk stratification and preventive strategies.

In the present study, nearly half of the patients (45.8%) reported chronic sun exposure, reflecting its established role as a major environmental determinant of cutaneous malignancies. With respect to skin type, the majority of patients belonged to Fitzpatrick type III (54.2%) and type IV (29.2%), while a smaller proportion (16.7%) were type II (fair-skinned). These findings are in line with the observations of Gandini et al.[15], who reported that lighter skin phototypes, particularly type I and II, carried a significantly higher risk of melanoma compared to darker skin tones, underscoring the role of pigmentation and susceptibility to actinic damage in the pathogenesis of skin cancers. In our series, smoking history was elicited in 15% of patients, which is consistent with earlier evidence suggesting a contributory role of tobacco exposure in the development of non-melanoma skin cancers, with some studies particularly highlighting an increased risk of basal cell carcinoma among heavy smokers [16,17]. A family history of cutaneous malignancy was present in 8.3% of cases, reaffirming its relevance as an inherited predisposition, although the proportion remains relatively small compared to other risk factors. Overall, these findings suggest that both environmental (sunlight, smoking) and host-related factors (skin type, family history) contribute in varying degrees to the risk of developing cutaneous malignancies in our population.

The association analysis revealed that chronic sun exposure was significantly higher among patients with SCC (70.0%) and MM (57.1%) compared to BCC (24.6%) and other malignancies (50.0%), with a p-value < 0.001, highlighting its important role as an environmental risk factor for cutaneous malignancies. In contrast, smoking history was more frequent among SCC patients (26.0%) compared to BCC (6.6%) and MM (14.3%), although this did not reach statistical significance (p = 0.08), indicating a possible trend that aligns with previous studies suggesting a contributory role of tobacco in SCC development [15]. Family history was uncommon across all malignancy types, ranging from 8.0% to 14.3%, and showed no significant association (p = 0.86), consistent with the generally low prevalence of hereditary predisposition in most population-based studies. Overall, these findings underscore that among the evaluated risk factors, chronic sun exposure is the primary determinant of cutaneous malignancy type in this tertiary care population, while smoking and family history appear to have more limited or variable influence.

 LIMITATIONS OF THE STUDY

This study had several limitations:

• Sample size may limit the generalizability of the findings.
• Findings may not be generalizable due to the specific population studied.
• The study's limited geographic scope may introduce sample bias, potentially affecting the broader applicability of the findings.

This study had several limitations:

• Sample size may limit the generalizability of the findings.
• Findings may not be generalizable due to the specific population studied.
• The study's limited geographic scope may introduce sample bias, potentially affecting the broader applicability of the findings.

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