INTRODUCTION

Skin cancers are malignant tumors that develop from one of the skin components, which may be epidermal, dermal, hypodermal, melanocytic, or adnexal in origin. These cancers are characterized by an uneven distribution worldwide [1]. Depending on the affected tissue, they may be carcinomas, melanomas, Kaposi’s sarcoma, or other types (sarcoma, lymphoma), differing in clinical, evolutionary, and histological expression [2]. According to the WHO, skin carcinomas are 15 to 20 times more frequent than melanomas. Between two and three million non-melanoma skin cancers are recorded worldwide [3]. In Africa, all histological types of skin cancer are observed, but with different proportions [4]. Their incidence has increased significantly in recent decades, although still relatively rare in the African literature [5]. The most frequent risk factors are exposure to UV rays, albinism, chronic ulcers, and burn scars. A biopsy with histopathological confirmation is necessary for diagnosis, evaluation, management, and prognosis [6]. In Guinea, Traoré B. et al. [2], in 2017, reported that the overall survival of patients with skin cancer after surgical treatment was 65.2%, with prognostic factors including iterative tumor resection, surgical margins, ulceration, and recurrence [7]. In general, cancer management is multidisciplinary. In our context, several difficulties are encountered, including late diagnosis, the high cost of chemotherapy, and the absence of radiotherapy. In the oncology department of Donka National Hospital, surgery has been the standard treatment since 2007. The global incidence of these cancers, their prevalence in Guinea, and the need to improve patient management and prognosis motivated this study, which aimed to assess the prognosis of skin cancers in the oncology department of Conakry.

MATERIALS AND METHODS

This was a retrospective cohort study conducted over 14 years, from April 11, 2007, to January 1, 2021. It included all histologically confirmed cases of skin cancer during the study period. Epidemiological aspects, characteristics of skin cancers, therapeutic approaches, and patient follow-up were described. Data was analyzed using SPSS 21.0 software. Categorical variables were expressed as frequencies or percentages, and quantitative variables as means (± standard deviations) or medians with interquartile ranges (IQR). Survival was calculated using the Kaplan–Meier method, and factors associated with survival were analyzed using the Cox model. A test was considered significant when p < 0.05.

RESULTS

We recorded 227 cases of skin cancer (Fig. 1), representing 1.3% of all cancers during the study period. The mean patient age was 45.8 ± 20.8 years. Males accounted for 51.5%, with a sex ratio of 1.02. Most patients resided in rural areas (51.5%), were married (65.2%), illiterate (73.1%), and had low socioeconomic status (81.5%). Hypertension (16.7%) and HIV (5.7%) were the main comorbidities. Risk factors included sun exposure (81.5%), albinism (10.1%), burn scars (8.4%), smoking (24.2%), and combined tobacco-alcohol use (15.0%). Patients consulted for swelling (70%), nodules (16.3%), or ulceration (13.6%), with a consultation delay greater than 6 months (65.6%). Lesions were ulcerative-proliferative (50.7%) and ulcerated (21.1%), infiltrative (60.8%), and unique (90.7%). The most common locations were the head and neck (46.2%) and lower limbs (37.9%). Histologically, non-melanoma epithelial carcinoma (70.9%) and melanoma (21.6%) were the most frequent. Tumors were mainly T4 (59.5%), with inguinal lymphadenopathy (39.2%) and stages III (79.7%) and IV (11.9%). Only 139 cases (61.2%) received specific treatment (Table 1): surgery (41.8%), chemotherapy (18.9%), and radiotherapy (1 case). Follow-up was less than 3 months in 63.3% of cases and more than 6 months in 25.9% (Table 2). Recurrence was observed in 23.0% of cases: local (53.1%), locoregional (6.3%), and metastatic (40.6%). At the last follow-up, 47.1% of patients were alive, 30.8% had died, and 22% were lost to follow-up. Overall 12-month survival was 23% (Fig. 2). Iterative surgery and initiation of treatment (surgery or chemotherapy) were statistically significant good prognostic factors (Table 3).

Figure 1: Distribution of selected patients by year.

	Table 1: Distribution of the patients according to specific treatments.
	Table 2: Distribution of the patients according to progression (recurrence) after treatment.

Figure 2: Overall survival curve for the patients with skin cancer.

Table 3: Distribution of the prognostic factors according to follow-up.

DISCUSSION

Over 14 years, we recorded a notable frequency of skin tumors (1.3%). This proportion is lower than that reported by Traoré B. et al. in the Journal of Cancer Therapy (7.8%) [7] and much lower than that of Diallo et al. in Senegal (16%) [8], but higher than that of Andrianarison M. et al. in Madagascar (0.5%) [1]. This difference may be explained by limited diagnostic and therapeutic facilities in Guinea and patient neglect. Our series was marked by a peak in 2018, possibly due to cancer screening campaigns. The mean age of patients was 45.8 years, lower than that reported in Burkina Faso (48.5 years) [5] and Morocco (57.7 years) [9]. This suggests skin cancer often affects older individuals with greater UV exposure. We observed a slight male predominance (sex ratio 1.02), similar to studies in the French Antilles [10] and other African reports [11,12], though Ouédraogo et al. [5] found female predominance in Burkina Faso. Tobacco use was significant (55%), and albinism was present in 10.1% of cases, higher than Mali (2.3%) [13,14]. The long consultation delay (average 21.4 months) contributed to advanced disease stages, worsened by traditional medicine and self-medication. Clinically, most tumors were ulcerative-proliferative, consistent with squamous cell carcinoma. Lesions were mainly located in the head/neck (46.2%) (Fig. 3) and lower limbs (37.9%), matching literature findings [15–17]. Histologically, squamous cell carcinoma predominated, while basal cell carcinoma was rare, as reported in African studies [2,5,7,8,18]. Advanced stage tumors (mostly T4) reflected delayed diagnosis. Surgery was the primary treatment (68.3%) (Figs 3 and 4), though access to radiotherapy remains absent in Guinea. Recurrence was observed in 23%, lower than Traoré et al. (28.8%) [7]. Overall 12-month survival was only 23%, compared to 75% at 5 years in India [19,20]. Poor outcomes reflect advanced presentation and limited treatment access. Prognostic factors included iterative resection and initiation of treatment, consistent with previous Guinea findings [7].

	Figure 3: Direct suture after a wide excision of a squamous cell carcinoma of the cheek in a 34-year-old female patient on postoperative day 1.
	Figure 4: Scar from a wide excision of a squamous cell carcinoma of the cheek in a 34-year-old female patient.

CONCLUSION

Skin cancer is a frequent pathology in our context. Advanced-stage diagnosis and limited access to treatment lead to poor prognosis for these otherwise curable cancers. Early diagnosis and appropriate management could significantly improve patient outcomes.

REFERENCES

1.  Malalaniaina A, Lovasoa T, Mamisoa RI, Malala R, Soavina RL, Florine R, et al. [Skin cancers in Madagascar:Where do we stand?]. Pan Afr Med J. 2019;34:167.

2.  Traore B, Keita M, CondéM, Keita M, Diane S, CisséM, et al. Caractéristiques anatomo-cliniques des cancers cutanés àl’unitéde chirurgie oncologique du CHU de Conakry. Rev CAMES SANTE. 2016;4:78-82.

3.  Organisation Mondiale de la Santé‹‹Cancer de la peau non mélanome ou carcinome cutanéet facteurs environnementaux››santé.fr 2018

4.  Didier B, Francès C, Guillot B, Guilhou JJ. Manifestations dermatologiques des maladies du système hématopoïétique et oncologie dermatologique. Paris:Springer Verlag;2009. XIV, 325

5.  Ouédraogo MS, Zongo N, Ouedraogo NA, Tapsoba GP, Korsaga/SoméNN, Nyamba YB, et al. Cancers cutanés sur peau noire en milieu tropical africain. Ann Dermatol Venereol 2015;142;389-90.

6.  Linares MA, Zakaria A, Nizran P. Skin cancer. Primary care:Clinics in office practice. 2015;42:645 59.

7.  Traore B, Lamah L. Outcomes of surgical treatment of skin cancer at Surgical Oncology Unit of Donka, Conakry University Hospital. JCT. 2017;08:1086-94.

8.  Diallo M, Dieng MT. Profils épidemiologiques et anatomo-cliniques des cancers cutanés au CHU Aristide Le Dantec de Dakar sur une période de 10 ans. Ann Dermatol Vénéréole. 2016;143:36.

9.  Bolac C, Cordel N, Deschamps L, Renier M, Quist D, Derancourt C, et al. [Diagnosis of skin cancer by dermatologists in the French West Indies:A prospective study]. Ann Dermatol Venereol. 2011;138:11-6.

10.  Bergeret B, Stoebner PE, Jardot M. Prévalence des cancers cutanés dans une cohorte rétrospective de patients sans abris. Ann Dermatol Venerol. 2022;2:A169.

11.  Kadakia S, Chan D, Mourad M, Ducic Y. The prognostic value of age, sex and subsite in cutaneous head and neck melanoma:A clinical review of recent literature. Iran J Cancer Prev. 2016;9;5079-82.

12.  Saka B, Souley Z, KombatéK, Mouhari-Toure A, Akakpo S, Napo-Koura G, Tchangaï-Walla K, PitchéP. [Skin cancers in Togo:A 223-case series]. Med Trop (Mars). 2010;70:169-71.

13.  Epidémiologie des cancers. Institut National du Cancer 2017 www.e-cancer.fr. Derrière mise àjour 19/03/2017.

14.  Almamy D, Lenga Loumingou IA, Mienwoley Armel O, Mutiyu Akanbi S, IrenéG, Anderson Stephen KA, et al. Squamous cell carcinoma on a Buruli ulcer graft scar:Ivory Coast. Our Dermatol Online. 2023;14:194-6.

15.  Samison LH, Randrianasolo P, Ravalisoa A, Ratrimoarivony C, Rapelanoro Rabenja F. Apport de Chirurgie sur les tumeurs basocellulaires àMadagascar. 1er Congrès de Dermatologie Vénéréologie de l’Océan indien, 2004.

16.  Fontaine J, Mielczarek S, Meaume S, Senet P. [Incidence of undiagnosed skin cancers in a geriatric hospital]. Ann Dermatol Venereol. 2008;135:651-5.

17.  Razafindrakoto R, Randrianandraina M, Rakotoarisoa A, Razanakoto G, Rakoto F. Les carcinomes basocellulaires de la face:àpropos de cinq cas malgaches. Rev Med Madagd. 2015;5:493-6.

18.  Asuquo M, Ebughe G. Cancers cutanés fréquemment rencontrés àl’hôpital universitaire de Calabar, àCalabar, dans le sud du Nigéria. Int J Dermatol. 2012;51:36 40.

19.  No authors. Prise en charge diagnostique et thérapeutique du carcinome basocellulaire de l’adulte. Ann Pathol. 2004;24:460-72.

20.  Deo SV, Hazarika S, Shukla NK, Cancersy T. Prise en charge chirurgicale de la peau Experience d’un centre regional de cancerologie du nord de l’inde. J Indien Cancer. 2005;42:145-50.