PRESENTATION, COURSE, AND OUTCOME OF HEAD AND NECK SKIN-CANCER IN AFRICAN-AMERICANS - A CASE-CONTROL STUDY

Background: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset dat a from these studies suggest that the course of head and neck skin can cer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. Methods: Retrospect ive case-control study including 215 patients with skin cancer (squamo us cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanom a, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period, Cases were defined as African Americans with skin c ancer, and the control group included white and Latin-American patient s with skin cancer. Results: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was les s common in African American patients (44%) than the control group (76 %; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often i nvolved. In the head and neck region, the ratio of BCC to SCC (4:1) wa s similar among all groups, In contrast, in non-sun-exposed regions, t he ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001), The overall distribution of malignant m elanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modalit y, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < . 001), their disease-free interval was similar to the control group. On ly the margin status was a significant predictor of disease-free survi val by multivariate analysis, with a relative risk of 1.68 (95% CI: 1. 58-18.24) Conclusions: Head and neck skin cancer is similar with regar d to presentation and distribution in patients of all skin types. More over, in contrast to previous reports, the course of head and neck ski n cancer may be less aggressive in African Americans, if appropriate t reatment is provided. This report suggests that differences in skin ca ncer in African Americans reported in the literature reflect cancer oc curring in non-sun-exposed regions.