Skin cancers

New data on anatomical distribution of NMSC will help prioritise excisions of lesions


Age and gender may influence non-melanoma skin cancer (NMSC) type and anatomical location, an Australian study has shown.

Plastic surgeons at Flinders Medical Centre, Adelaide reviewed 22,303 NMSC excisions performed at the hospital between January 2012 and December 2017.

After mapping NMSC lesions across 100 skin regions and accounting for age and gender, the investigators found that 80% were excised from the head and neck and 57%  were basal cell carcinomas (BCC).

As expected, NMSC excisions generally increased with increasing age, peaking in 60–79 year olds and slightly decreasing in people 80 years old and above.

The researchers then investigated whether the location pattern of NMSC was affected by exposure to UV radiation and by gender.

Their retrospective analysis showed that:

    • BCC excisions were significantly higher in the anterior scalp, median forehead and lumbosacral back regions than SCC based on age (P < 0.01)
    • Squamous cell carcinoma (SCC) excisions were significantly higher in certain areas of the face, lip, neck, lower limb, back and scalp based on age (P < 0.01)
    • BCC and SCC excisions were more frequent in males than females, occurring 66% and 77% of the time, respectively
    • For BCC:
      • More males had BCC excisions in the ear regions
      • More females had BCC excisions in the nasal, lip and ankle regions
    • For SCC:
        • More males had scalp excisions
        • More females had leg and lip excisions

The investigators said the gender-based regional differences may be explained by factors such as differences in gender-specific activities, UV exposure based on hair coverage and earlier hair loss in males, potentially increased occupational UV exposure in males and differences in clothing patterns (which may reflect why females had significantly more NMSC on the lower leg).

However, “several skin regions, including the side, posterior and subclavicular neck did not show an apparent relationship in total NMSC excisions varying with gender or age, even with significant predilection for one NMSC type”.

The researchers said they hoped a better understanding of NMSC predilections based on location, age and gender will help clinicians triage patients prioritise excisions of SCC lesions which “more commonly demonstrate metastatic potential”.

“This has the potential to refine urgency rankings of skin excisions which is important given that SCC has a greater potential for metastatic disease,” they wrote.

The findings are published in the Australia and NZ Journal of Surgery.

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