| کلیدواژههای انگلیسی مقاله |
cancer, melanoma, epidemiology, Kermanshah, INTRODUCTIONSkin cancers are among the most prevalent cancers in humans, and one million cases of non-melanoma cancers are recognized in USA annually. In the Islamic Republic of Iran, skin cancer is the most prevalent cancer, with a male-to-female ratio of 1.6, observed in the seventh and eighth decades of life 1, . The prevalence of different types of skin cancer has increased in recent decades, and since most of these cancers originate from prolonged exposure to sunlight, atmosphere changes and especially change in ozone thickness along with changes in personal and social habits can justify this increase 1,, 2, .Skin cancer is a major health problem. In most countries, different types of skin cancer are prevalent and are increasing rapidly. Despite decreased cancer in recent years, 3 to 5% is added to the amount of cancroid annually with the possibility of prevention and treatment 3, . In Iran, limited studies have been done, and the reported prevalence of different types of skin cancer is between 10 to 15 cases in every 10,000 persons annually 4, . Disability, cosmetic problems, and high costs of this disease, especially its long-term form, cause this cancer to be a general health problem in most communities 5, .Basal cell carcinoma is the most prevalent malignant tumor in whites, and squamous cell carcinoma is the second most prevalent tumor of the skin, accounting for about 20% of cancers 6, and representing one of the deadliest cancers that originate from epidermis melanocytes .Squamous and basal cell carcinomas are the most prevalent types of cancer throughout the world and in Iran . Malignant melanoma includes 4% of all cancer cases, but it is the cause of death in about 79% of types of cancer 10, .Malignant melanoma prevalence increased in the last decades in many parts of the world. The prevalence of this malignancy has tripled in the last 40 years, which has been more than any other malignancy 11,, 12, . Melanoma prevalence is lower in Middle-Eastern countries like Iran in comparison to Europe and USA .When melanoma turns malignant, it becomes resistant to treatment and apoptosis and causes metastasis in deep parts of the skin and internal organs such as the spleen, liver, and lymph nodes 14, . In clinical terms, malignant melanoma is usually without symptoms. Although itching may be one of the initial signs of the disease, a change in the size or color of a pigmented lesion is the most important clinical manifestation 15, . The most critical histologic finding is radial and vertical growth. Radial growth is the initial trend to grow in a horizontal direction within the epidermis and surface dermal layers, which lack metastasis ability. In vertical growth, melanoma grows into deep dermal layers and causes metastasis 16, . Growth of an old mole, itching or pain in an old mole, formation of a new pigmented lesion, irregularity in the edges of a pigmented lesion, and color change are among the most important signs of melanoma in clinical examinations 15,- 17, .Risk factors involved in the formation of cancroid and especially malignant melanoma are sunlight, light skin, big congenital moles, immunosuppression, genetic polymorphisms, alcohol use, numerous freckles, genetic factors, and familial melanoma history 18,, 19, .Although limited studies have been conducted on some epidemiologic characteristics and indices of malignant melanoma in Iran , they are quite dated, and new information is needed for policy-making. Therefore, the current study was done to examine the epidemiology of malignant melanoma in the Kermanshah province of Iran during 2010-2017 to guide health policy-makers.MATERIALS AND METHODSData resourcesThe study population of this descriptive study included melanoma patients from 14 cities of Kermanshah province, Eslamabad-e Gharb, Ravansar, Paveh, Javanrood, Sarpol-e-Zahab, Sahneh, Hersin, Dalahoo, Salas-e-Babajani, Gilan-e Gharb, Qasr-e Shirin, Kangavar, Sonqor, and Kermanshah City. The patients were visited at the Imam Reza Hospital and Haj Daei Dermal Specialty Center from April 2010 to February 2017. These patients were diagnosed with melanoma based on American Joint Committee on Cancer, and their information was registered in the Kermanshah University of Medical Sciences registry system. This study was approved by the Ethics Committee of the Kermanshah University of Medicine Sciences.Population and scope of KermanshahKermanshah, with an area of 25,009 km2, is one of the biggest provinces in Iran. Kermanshah makes up 5.1% of Iran and is among the western provinces, sharing the border with Iraq. This province is limited in the north by Kurdistan, south by Lorestan and Ilam, east by Hamadan, and west by Iraq. Kermanshah City is the capital of Kermanshah province. The population of this province was 1,977,000 in 2015, with 71.1% of people living in urban areas (Figure 1,). Figure 1. Map of Iran showing Kermanshah (cities are shown in the inset)Statistical analysisData were analyzed by using SPSS 20. The results were shown based on Kermanshah&apos,s geography in ArcGIS (Arc MAP, Version 10.7) software in order to provide more comprehensive results. All of the maps used in the paper were extracted from the software and were not obtained from other sources and articles.RESULTSThis study included 70 patients, 46 men (65.7%) and 24 women (34.3%), aged 60.49 &,plusmn 16.08. Melanoma prevalence in Kermanshah province was about 4.4 in every 1,000,000 persons annually.Based on the results in Table 1, and the demographic and epidemiologic status of malignant melanoma patients, most cancer cases were in 2015 (18 cases, 25.7%), while the fewest were in 2016 (4 cases, 5.7%). Notably, 46 patients (65.7%) had skin type III, 18 patients (25.7%) had skin type II, and 6 patients (8.6%) had skin type IV. Moreover, 43 (61.4%) had indoor jobs and 47 (67.1%) lived in the city.VariableFrequency (%)Age60.49 &,plusmn 16.08SexMale46 (65.7%)Female24 (34.3%)Skin typeType II18 (25.7%)Type III46 (65.7%)Type IV6 (8.6%)Occupational StatusIndoor43 (61.4%)Outdoor27 (38.6%)LocationUrban47 (67.1%)Rural23 (32.9%)Risk factorTrauma25 (35.7%)Smoking18 (25.7%)History of melanoma8 (11.4%)Atypical mole3 (4.3%)Weak immune system2 (2.8%)Freckles2 (2.8%)Anatomical location of the infectionExtremities36 (51.4%)Head and neck28 (40%)Trunk6 (8.6%)Family history of melanoma2 (2.8%)Types of skin cancersBasal cell carcinoma8 (11.4%)Squamous cell carcinoma3 (4.3%)Basal cell and squamous cell carcinoma1 (1.4%)Diagnostic accuracyAs the first diagnosis46 (65.7%)As a second diagnosis19 (27.1%)As a third diagnosis3 (4.3%)Lack of diagnosis2 (2.8%)Table 1. Examining the demographic and epidemiologic status of malignant melanoma patientsTwenty-five patients (35.7%) had trauma history, eighteen patients (25.7%) smoked, eight patients (11.4%) had familial melanoma history, three patients (4.3%) had atypical moles, and two patients (2.8%) had freckles. Sixty-eight patients (97.1%) did not have an immune system dysfunction history or immunosuppressing drug use history, and the most prevalent anatomic site of lesions in patients was the extremities (36 cases, 51.4%), where 23 cases (32.8%) were observed in the lower extremities, and 13 cases (18.5%) were observed in the upper extremities (Table 1,).Two patients (2.85%) had familial melanoma history. Twelve patients (17.1%) had a history of other types of skin cancer, including basal cell carcinoma in 3 (4.3%), squamous cell carcinoma in 8 (11.4%), and both in 1 patient (1.4%). In addition, examining the pathologic files of the patients revealed that the physician recognized melanoma at the first, second, and third visit for 46 (65.7%) patients, 19 (27.1%) patients and 3 (4.3%) patients, respectively. Melanoma recognition was not stated only for 2 (2.8%) patients (Table 1,).The clinical examination of patients showed that among the clinical forms of acral lentiginous melanoma, superficial spreading, malignant lentigo, nodular, malignant melanoma without initial origin, and malignant melanoma on an atypical mole were observed in 35 (50.1%), 16 (22.8%), 10 (14.3%), 7 (10%), 2 (2.8%), respectively (Table 2,). Involvement of inguinal lymph nodes was observed in 10 patients (14.3%), neck nodes in 3 patients (4.3%), and axillary nodes in 2 patients (2.8%). Pathologic examination of lesions revealed that Clark level II, III, IV, and V were observed in 2 (2.9%), 16 (22.8%), 43 (61.4%), and 9 (12.8%) patients, respectively (Table 2,).VariableFrequency (%)Clinical type of acral lentiginous melanomaSurface extension35 (50.1%)Malignant lentigo16 (22.8%) |