Godwin Ebughe

Marjolin's ulcer: the importance of surgical management of chronic cutaneous ulcers

Chronic cutaneous ulcers are commonplace in the developing world, especially in rural areas with poor living conditions and often result from the trauma of road‐traffic injuries. Chronic cutaneous ulcers may also be due to vascular insufficiency, neuropathy, nodular leprosy, pressure, diabetes, or hemoglobinopathies, or they may be tropical ulcers. If poorly managed, these lesions may undergo malignant transformation. We evaluated the clinical histories and treatment outcomes of patients seen at the University of Calabar Teaching Hospital, between January 2000 and December 2004, who had histologic diagnosis of Marjolins ulcer, in an attempt to identify risk factors for this problem. The six patients were men, age 30–70 years (mean, 42 years). Trauma was the leading cause of injury leading to ulceration: road‐traffic accidents (four patients, 66.7%), fall (one patient, 16.7%), and flame burn (one patient, 16.7%). Most injuries involved the limbs: lower (four patients, 66.7%) and upper (one patient, 16.7%). The histologic diagnosis in all the cases were squamous cell carcinoma and mean latency period from injury to diagnosis of malignancy was 18.5 years. All the patients had been admitted because of poor results from topical treatment. Three patients (50%) were managed with wide excision and skin grafting with the lesions healed. Ignorance as well as economic and sociocultural factors were the underlying issues. Education concerning the risks associated with chronic wounds and the need for prompt and proper surgical management are recommended.

Major dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria.

AbstractBackground: Dermatologic malignancies are among the most common form of cancer. However, dark-skinned individuals of African descent are said to be far less likely than fair-skinned individuals to develop skin cancer. Significant differences in the pattern of skin malignancy have also been observed in different regions of Africa. Objective:The aim of this study was to evaluate the pattern, site incidence, and outcome of treatment of major histologically diagnosed dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria. Methods: We evaluated patients with histologic diagnoses of major dermatologic malignancies that presented to the University of Calabar Teaching Hospital, Calabar, Nigeria between January 2000 and December 2004 and compared our findings with the total number of patients diagnosed with malignancies at the same hospital over the same period. This hospital is located in South Nigeria. Results: There were 63 histologically diagnosed dermatologic cancers, comprising 10% of all histologically diagnosed cancers at the University of Calabar Teaching Hospital during the study period. Squamous cell carcinoma (SCC) was the most common (n = 23; 37%), followed by Kaposi sarcoma (KS) [n = 17; 27%]. Other malignancies included basal cell carcinoma (BCC), melanoma, and dermatofibrosarcoma protuberans (DFSP) [n = 5; 8% each]. The peak age varied with the type of cancer but none was found in patients in the first decade of life. The lower limb was the most frequent site of SCC (Marjolin ulcer), KS, and melanoma, while BCC was most common on the head, neck, and upper limb. Excision surgery resulted in healing of all cases of BCC. Some patients with SCC and melanoma presented late for curative surgery. Some African KS tumors were chemo- sensitive. There was a high recurrence rate for DFSP. Conclusion: This study revealed a similar pattern of dermatologic malignancies in South Nigeria compared with other parts of Africa but also some regional differences (e.g. in Kano, melanoma ranked second). The pattern was, however, in sharp contrast to that seen with Caucasian populations, in whom 80% of the lesions are BCC and 20% are SCC. Public education, implementation of preventive strategies, and early presentation of disease would improve outcomes of dermatologic malignancies in Nigeria.

Basal cell carcinoma in five albino Africans from the south‐eastern equatorial rain forest of Nigeria

Background  Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the white population and occurs infrequently in dark‐pigmented individuals. Albinism is an established risk factor for skin cancer in black Africans.

Kaposi Sarcoma: Changing Trend In Calabar, South Eastern Nigeria

BACKGROUND/OBJECTIVE Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency, current clinical pattern, and anatomic distribution of KS in Calabar, south-eastern Nigeria and compare this with total malignant skin tumour. METHOD All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay. RESULTS In our study, there were 11 patients (7 males and 4 females), with a male: female ratio of 1.75:1. This was the commonest malignant skin tumor (38%) followed by squamous cell carcinoma (SCC) (34.5%) and the age ranged from 21-60 years (mean 42.9 years). Nine patients (81.8%) were HIV positive including the 4 females (age ranged from 21-45 years) and 2 (18.2%) HIV negative, aged 59 and 60 years. The lower limb was the commonest site (50%). Atypical lesions involved the eyelids/nose and penis. CONCLUSION KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour.

Skin cancers amongst four Nigerian albinos.

Background  Albinism is an established risk factor for skin cancer in black Africans, and high levels of ultraviolet radiation increase the risk of the three major forms of skin cancer.

Dermatofibrosarcoma protuberance: case reports.

BACKGROUND Dermatofibrosarcoma protuberance (DFSP) is a relatively uncommon soft tissue neoplasm with intermediate to low grade malignancy, rarely metastasizing to regional lymph node or distant site but with proclivity for local recurrence due to inadequate resection. METHODS We evaluated the clinical histories and treatment outcomes of five consecutive patients who had histologic diagnosis of DFSP in the University of Calabar Teaching Hospital between 2000 and 2004. RESULTS The five cases reported had histologic diagnosis, sought for after excision. The male:female ratio was 2:3 with an age range of 17-35 years (mean, 26.6 years). Two of the lesions involved the neck and the other three sites involved were the anterior chest wall, groin and proximal thigh. Three of the lesions were recurrent. CONCLUSION DFSP is an uncommon tumour, painless, cutaneous and multilobulated lesions should arouse the suspicion of this tumour. Early presentation, pre-operative histologic diagnosis and postoperative evaluation of resection margins would enhance the goal of ensuring adequate excision for improved outcome.

Major dermatological malignancies encountered in the University of Calabar Teaching Hospital, Calabar, southern Nigeria.

Background  Dermatologic malignancies are among the most common forms of cancer. Sun exposure is the major risk factor in white people, while non‐solar factors appear to be the leading risk factor in the darkly pigmented.

Cutaneous squamous cell carcinoma in Calabar, southern Nigeria

Background.  Several studies have shown that in Africa squamous cell carcinoma (SCC) is commoner than other skin malignancies. The risk factors are grouped generally into solar and nonsolar factors and their contributions vary with race, geographical region and site of lesion. This study attempted to identify risk factors and outcome of management of this problem in our region of southern Nigeria.

Paucity of HPV-Related Head and Neck Cancers (HNC) in Nigeria

Introduction The burden of HPV-related Head and Neck Cancers (HNC) has been rising in the U.S. and other developed countries but this trend has not been reported in Africa. Objective of study was to evaluate the prevalence of HPV infection in HNC cancer cases seen between 1990 and 2011 at the tertiary health care institutions in Nigeria. Methods We retrieved 149 head and neck cancer formalin fixed, paraffin embedded tumor specimens diagnosed between 1990 and 2011 from four teaching hospitals in Nigeria. One hundred and twenty-three blocks (83%) contained appropriate HNC for analysis while DNA extraction was successful in 60% (90/149). PCR amplification was successful in 33% (49/149) and Linear Array genotyping for HPV was successful in 11% (17/149) of these cases. These were in tumors from the larynx (6), cervical lymph nodes (3), nasal cavity (2), parotid (1), palate (1), maxillary sinus (1) and mandible (1). Two cases were non-specific and none were from the oropharynx. Histologically, 41% (7/17) of the successfully genotyped blocks were squamous cell carcinomas (larynx 6, maxillary sinus 1). Results and Conclusion We were unable to detect HPV in any of the HNC samples in our study. Our result may suggest that there is a low prevalence of HPV-related HNC among the adult population in Nigeria. Our results provide a benchmark to compare future incidence of HPV -related HNC in this community in future. We had significant analytical challenges from possible poor tissue processing and urge that future studies should prospectively collect samples and ensure high quality sample processing.

Kaposi Sarcoma in Calabar, Southern Nigeria

OBJECTIVES There has been an increase in the prevalence of Kaposi sarcoma (KS) with the emergence of Human Immunodeficiency Virus (HIV). METHODS Patients with histologic diagnosis of KS seen in the University of Calabar Teaching Hospital, Calabar between January 2007 and December 2008 were studied. Diagnosis of HIV was based on enzyme linked immunosorbent assay (ELISA). RESULTS In total, 15 patients (10 males, 5 females, M: F=2:1) presented with KS and accounted for 33.0% of total skin malignancy and ranked second after squamous cell carcinoma, 42.0%. Their ages ranged from 5 and 60 years (mean 37.5 years). Twelve patients (M=8, F=4), 80%, were HIV seropositive, while 3 (M=2, F=1) were HIV seronegative. The lower limb was the commonest affected site, 57.9%. CONCLUSION The most common clinical type was HIV related KS. Ignorance, sociocultural beliefs, poverty, late presentation were underlying issues.