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A Histopathological Study of Skin Lesions in Individuals with Oculocutaneous Albinism in Togo in 2019

A Histopathological Study of Skin Lesions in Individuals with Oculocutaneous Albinism in Togo in... Hindawi Journal of Skin Cancer Volume 2020, Article ID 2361957, 4 pages https://doi.org/10.1155/2020/2361957 Research Article A Histopathological Study of Skin Lesions in Individuals with Oculocutaneous Albinism in Togo in 2019 1 2 1 3 Bayaki Saka , Julienne Noude Teclessou , Sefako Abla Akakpo , Piham Gnossike, 4 5 6 1 Kwame´ Doh, Saliou Adam, Abas Mouhari-Toure, Garba Mahamadou, 1 7 8 2 Panawe´ Kassang, Yvette Elegbede Moise, Tchin Darre , Koussake Kombate, and Palokinam Pitche´ Service de Dermatologie et IST, CHU Sylvanus Olympio, Universit´e de Lom´e, Lom´e, Togo Service de Dermatologie et IST, CHU Campus Universit´e de Lom´e, Lom´e, Togo Centre National de Dermatologie de Gbossime´, Lome, Togo Unit´e D’histopathologie, Clinique M´elia, Lom´e, Togo Service de Chirurgie Maxillo-Faciale et Plastique, CHU Sylvanus Olympio, Universit´e de Lom´e, Lom´e, Togo Service de Dermatologie et IST, CHU Kara, Universite´ de Kara, Kara, Togo Service de Dermatologie et IST, Centre Hospitalier R´egional de Tomd`e, Kara, Togo Laboratoire D’anatomie et Cytotologie Pathologique, CHU Sylvanus Olympio, Universit´e de Lom´e, Lom´e, Togo Correspondence should be addressed to Julienne Noude Teclessou; tjulie06@yahoo.fr Received 6 May 2020; Accepted 9 July 2020; Published 29 July 2020 Academic Editor: Silvia Moretti Copyright © 2020 Bayaki Saka et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. *e aim of this study was to study the histopathological patterns of skin lesions in persons with albinism (PWA) in Togo in 2019. Method. During two mobile skin care clinics in 2019, biopsies/excisional biopsies were performed in PWA in case of clinical doubt or in front of lesions suspected to be cancerous for histological examination. Anatomopathological reports were thus analysed. Results. During the two mobile skin care clinics, 115 biopsies/excisional biopsies were carried out in 79 PWA, with a mean age of 24±16.1 years. Histological examination led to a diagnosis in 110 cases (95.6%) and was inconclusive in 5 cases (4 cases of uncertain histological diagnosis and one case of nonspecific histological lesions). Fourteen different histological diagnoses were made, with a frequency ranging from 0.9% (one case) to 26.9% (31 cases). *e four most frequent diagnoses in descending order were basal cell carcinomas (BCCs) (31 cases; 26.9%), invasive squamous cell carcinomas (SCCs) or Bowen’s disease (23 cases; 20%), keratosis (20 cases; 17.3%), and cysts (seven cases; 6.1%). *e 54 skin carcinomas were diagnosed in 33 (41.8%) of the 79 patients who underwent skin biopsies/excisional biopsies. *e BCC/SCC ratio was 1.3. No cases of cutaneous melanoma had been diagnosed. Conclusion. Skin cancers represent the main histological diagnosis in PWA (46.9%) in Togo in 2019. *e pattern of cutaneous malignancies in PWA shows the same trend as that seen in Caucasians with a predominance of basal cell carcinomas. risk of skin cancer [4–6]. *e diagnosis of skin diseases in 1. Introduction PWA very often requires histological examination [2, 7–9], Oculocutaneous albinism is an inherited disease charac- especially in the case of skin lesions suspected of being terized by the total or partial absence of melanin in the skin, cancerous. Indeed, the fear of the practitioner is the early hair, and eyes [1, 2]. Melanin, the pigment responsible for detection of these skin cancers in this population because of skin colour, is photoprotective against carcinogenic ultra- their very high frequency, varying from 23 to 26% depending violet radiation [3]. Its deficiency in people with albinism on the series [9–12]. We conducted this study in order to (PWA) predisposes them to the harmful effects of this ra- study the histopathological patterns of skin lesions in per- diation, with the development of actinic damage and a major sons with albinism (PWA) in Togo in 2019. 2 Journal of Skin Cancer in PWA is especially when skin lesions are suspected to be 2. Method malignant, as the practitioner’s obsession is the early de- Two rounds of free mobile skin care clinics took place tection of these skin cancers in this population because of throughout the Togolese territory in 2019 in order to treat their very high frequency [9–12]. In the series of Ene- malignant and premalignant lesions in PWA. *ese cam- chukwu et al. [9], skin biopsy was performed on suspicion paigns covered 10 cities in Togo, the first in June and July of premalignant or malignant lesions in 38% and 32% of 2019 and the second in October and November 2019. cases, respectively. Dermatological consultations were provided by a senior Histological examination resulted in a histological di- dermatologist. Biopsies/excisional biopsies were carried out agnosis of certainty in 110 (95.6%) of the 115 biopsies/ex- in case of clinical doubt or in front of lesions suspected of cisional biopsies in our study. In a French study on penile being malignant and sent to the laboratory of pathology of dermatosis in the general population [13], this histological the Sylvanus Olympio University Hospital or to the histo- examination led to a diagnosis in 85.5% of cases. Rajaratnam pathology unit of the Melia ´ clinic in Lome´ for histological et al. [14] in Ireland found in the study of general population examination. Two pathologists assisted in carrying out the that, in 55% of cases of inflammatory dermatosis, histology histological examinations. Anatomopathological reports led to a diagnosis of certainty, even without any clinical were collected and analysed. *e data collected were soci- information provided to the pathologist. *ese results show odemographic (age and sex) and histological diagnosis. the value of histology in dermatology for the diagnosis of skin diseases. In our study, 33 (41.8%) of the 79 patients who had 3. Results undergone biopsies/excisional biopsies had skin carcino- During these two campaigns, 115 biopsies/excisional bi- mas (BCCs in 26.9% of cases and invasive or in situ SCC in opsies were carried out for histological examination in 79 20% of cases). Other histological diagnoses were dominated patients, with an average of 1.5 biopsies/excisional biopsies by keratosis (17.3%), cysts (6.1%), hamartoma (6.2%), per PWA. Indeed, 24 of the 79 patients had more than one nodular folliculitis (6.1%), and benign squamous papillo- biopsy/excisional biopsy (15 had two biopsies/excisional mas (6.1%). In the series of Enechukwu et al. [9], 18 (60%) biopsies, 6 had three biopsies/excisional biopsies, and 3 had of the 30 patients biopsied had skin carcinomas including four biopsies/excisional biopsies). *e mean age of the 79 BCC (37.9%), SCC (15%), basosquamous carcinoma (12%), patients was 24±16.1 years (extremes: 7 and 75 years), and and collision tumour (BCC and SCC, 3.4%). Other his- the sex-ratio (M/F) was 1. All of these 115 biopsies were tological diagnoses were actinic keratosis (15%), nevi (12%), cutaneous. solar elastosis (1.2%), and psoriasis (1.7%). From these two Histological examination led to a diagnosis in 110 cases studies, premalignant and malignant dermatosis were (95.6%) and was inconclusive in 5 cases, including 4 cases of found to be the main histological diagnosis in PWA (46.9% uncertain histological diagnosis and 1 case of nonspecific in our series versus 83.3% in the Nigerian series [9]). *ese histological lesions. results confirm the impact of the sun, with a high preva- Fourteen different histological diagnoses were made, lence of actinic damage and skin cancer. Indeed, the ap- with a frequency ranging from 0.9% (one case) to 26.9% (31 pearance of actinic lesions in PWA is not only related to age cases). *e four most frequent diagnoses in descending [4, 10] but also and especially to the hot and sunny climate order were basal cell carcinomas (BCCs) (31 cases; 26.9%), [15, 16]. invasive squamous cell carcinomas (SCCs) or Bowen’s In our study, there was a predominance of BCC with a disease (23 cases; 20%), keratosis (20 cases; 17.3%), and cysts BCC/SCC ratio of 1.3. *is predominance could be (seven cases; 6.1%) (Table 1). *e 54 cutaneous carcinomas explained by the fact that, in our case, it is the dermatologist were diagnosed in 33 (41.8%) of the 79 patients who un- who goes to the PWA, which allows us to detect mild cases. derwent skin biopsies/excisional biopsies. *e BCC/SCC In Nigeria [9], BCC was also the most frequent skin car- ratio was 1.3. No cases of cutaneous melanoma had been cinoma (55%), followed by SCC (22%), basosquamous diagnosed. carcinoma (12%), and collision tumour (BCC and SCC, 3.4%). In Brazil [10], 62% were BCC, 51% were SCC, and 7% were melanoma. All three studies, including ours, were 4. Discussion population-based studies. However, most of the African studies, all hospital series, show that SCC is the most In our study, 115 biopsies/excisional biopsies were per- common cancer in this population [2, 17–19]. Finally, formed in 79 PWA, an average of 1.5 biopsies/excisional melanoma is rare in PWA with a similar incidence in the biopsies per PWA. *is rate is comparable to that found general population [10], a tumour that was not by us and (1.6 biopsies per PWA) in Tanzania where 134 biopsies Enechukwu et al. [9]. were performed on 86 PWA [2]. In Nigeria [9], 58 biopsies Limitations of study: the main limitation of this study is were taken from 30 PWA, corresponding to 1.9 PWA that histological examinations were performed by general biopsies. *ese results show that suspicious skin lesions pathologists and not dermatopathologists. Nevertheless, in requiring skin biopsy are most often multiple in the same 95.6% of cases, the histological examination made a PWA, probably due to the effects of ultraviolet radiation. diagnosis. Moreover, the main reason for biopsies/excisional biopsies Journal of Skin Cancer 3 Table 1: Histological diagnosis in PWA in Togo in 2019. Histological diagnostics Number (%) Basal cell carcinomas 31 26.9 Squamous cell carcinomas (in situ and invasive) 23 20.0 Keratosis 20 17.3 Cysts (epidermal, synovial, and sebaceous) 7 6.1 Hamartomes (folliculo-sebaceous, verruca sebaceous, and angiocrine) 6 5.2 Nodular folliculitis 6 5.2 Benign squamous papillomas 6 5.2 Hyperplastic fleshy buds 4 3.5 Lipomes 2 1.7 Plantar wart 1 0.9 Psoriasis 1 0.9 Supposedly benign round cell tumour 1 0.9 Ulcerated benign lobular hemangioma 1 0.9 Boil 1 0.9 Nonspecific skin ulceration 1 0.9 Histological diagnosis uncertain 4 3.5 Total 115 100 Actinic (2); benign (14); HPV/wart (4). 5. Conclusion Conflicts of Interest *e results of this study show that skin cancers represent the *e authors declare that they have no conflicts of interest. main histological diagnosis in PWA (46.9%) in Togo in 2019. *e pattern of cutaneous malignancies in PWA shows the Authors’ Contributions same trend as that seen in Caucasians with a predominance of basal cell carcinomas. *e popularization and respect of BS, PP, and GM were responsible for the conception of the photoprotection measures and systematic and regular ex- study, participated in the study design, undertook the field amination of the skin of these PWA will allow early detection study, conducted the data collection, analysis, and inter- and management of these skin cancers. pretation, and wrote the manuscript. *ey have revised and finalized the manuscript. JNT, PK, SA, SAK, PG, and YEM were involved in the data collection, analysis, and inter- Abbreviations pretation. *ey wrote and finalized the manuscript. AMT, ANAT: National association of albinos of Togo TD, and KK were involved in data analysis and interpre- BCC: Basal cell carcinoma tation. All the authors were responsible for the overall NGO: Nongovernmental organization scientific management of the study, for analysis and inter- PWA: Patients with albinism pretation, and the preparation of the final manuscript. Fi- SCC: Squamous cell carcinoma nally, all the authors read and approved the final manuscript SOTODERM: Togolese society of dermatology and sexually to be submitted for publication. transmitted infections UV: Ultraviolet. Acknowledgments Data Availability *e authors would like to thank the Pierre Fabre Foundation for fully funding this dermatological consultation project for Extracted data are with the authors and available for sharing people with albinism (PWA) in Togo. *e authors also thank on request. the National Association of Albinos of Togo (ANAT) for coordinating the PWA mobile clinics in 2019. Ethical Approval References *is study was authorized and approved by the National Association of Albinos of Togo (ANAT), the Togolese So- [1] E. S. Hong, H. Zeeb, and M. H. Repacholi, “Albinism in Africa ciety of Dermatology and Sexually Transmitted Infections as a public health issue,” BMC Public Health, vol. 6, p. 212, (SOTODERM), the Maxillofacial and Plastic Surgery De- partment, and the Ministry of Health of Togo. [2] S. K. Kiprono, B. M. Chaula, and H. Beltraminelli, “Histo- logical review of skin cancers in African albinos: a 10-year Consent retrospective review,” BMC Cancer, vol. 14, pp. 1471–2407, *e authors obtained oral consent from patients who par- [3] M. Sengupta, D. Sarkar, M. Mondal, S. Samanta, A. Sil, and ticipated in the study. K. Ray, “Analysis of MC1R variants in Indian oculocutaneous 4 Journal of Skin Cancer albinism patients: highlighting the risk of skin cancer among albinos,” Journal of Genetics, vol. 92, no. 2, pp. 305–308, 2013. [4] S. E. Emadi, A. Juma Suleh, F. Babamahmoodi et al., “Common malignant cutaneous conditions among albinos in Kenya,” Medical Journal of the Islamic Republic Of Iran, vol. 31, no. 1, 2017. [5] A. N. Okoro, “Albinism in Nigeria: a clinical and social study,” British Journal of Dermatology, vol. 92, pp. 485–492, 1975. [6] J. Luande, C. I. Henschke, and N. Mohammed, “*e Tan- zanian human albino skin: natural history,” Cancer, vol. 55, no. 8, pp. 1823–1828, 1985. [7] G. Van Der Westhuizen, C. A. Beukes, B. Green, W. Sinclair, J. Goedhals, and J. Goedhals, “A histopathological study of melanocytic and pigmented skin lesions in patients with al- binism,” Journal of Cutaneous Pathology, vol. 42, no. 11, pp. 840–846, 2015. [8] M. I. Perez and J. L. Sanchez, “Histopathologic evaluation of melanocytic nevi in oculocutaneous albinism,” 8e American Journal of Dermatopathology, vol. 7, pp. 23–28, 1985. [9] N. A. Enechukwu, G. O. Ogun, O. I. Ezejiofor et al., “His- topathologic patterns of cutaneous malignancies in individ- uals with oculocutaneous albinism in anambra state, Nigeria: a paradigm swing?” Ecancer Medical Science, vol. 14, p. 1013, [10] C. R. Marçon, J. C. Moraes, M. A. M. De Olivas Ferreira, and C. B. Oliari, “Dermatological and epidemiological profiles of patients with albinism in são paulo, Brazil, between 2010 and 2017: a cross-sectional study,” Dermatology, vol. 236, no. 3, pp. 219–227, 2020. [11] D. P. Lookingbill, G. L. Lookingbill, and B. Leppard, “Actinic damage and skin cancer in albinos in northern Tanzania: findings in 164 patients enrolled in an outreach skin care program,” Journal of the American Academy of Dermatology, vol. 32, no. 4, pp. 653–658, 1995. [12] J. G. Kromberg, D. Castle, E. M. Zwane, and T. Jenkins, “Albinism and skin cancer in southern Africa,” Clinical Ge- netics, vol. 36, no. 1, pp. 43–52, 1989. [13] J.-N. Dauendorffer, C. Renaud-Vilmer, M. Bagot, and B. Cavelier-Balloy, “Inter ´ et ˆ de la biopsie cutan´ee dans le di- agnostic des dermatoses peniennes,” ´ Annales de Dermatologie et de V´en´er´eologie, vol. 139, no. 8-9, pp. 521–525, 2012. [14] R. Rajaratnam, A. G. Smith, A. Biswas, and M. Stephens, “*e value of skin biopsy in inflammatory dermatoses,” 8e American Journal of Dermatopathology, vol. 31, no. 4, pp. 350–353, 2009. [15] C. Y. Wright, M. Norval, and R. W. Hertle, “Oculocutaneous albinism in sub-saharan Africa: adverse sun-associated health effects and photoprotection,” Photochemistry and Photobiol- ogy, vol. 91, no. 1, pp. 27–32, 2015. [16] C. Y. Wright, D. J. Du Preez, D. A. Millar, and M. Norval, “*e epidemiology of skin cancer and public health strategies for its prevention in southern africa,” International Journal of Envi- ronmental Research and Public Health,vol.17,no.3,p.1017,2020. [17] J. B. Mabula, P. L. Chalya, M. D. Mchembe et al., “Skin cancers among albinos at a university teaching hospital in north- western Tanzania: a retrospective review of 64 cases,” BMC Dermatology, vol. 12, no. 1, p. 5, 2012. [18] O. Awe and T. Azeke, “Cutaneous cancers in Nigerian albinos: a review of 22 cases,” Nigerian Journal of Surgery, vol. 24, no.1, pp. 34–38, 2018. [19] K. O. Opara and B. C. Jiburum, “Skin cancers in albinos in a teaching hospital in eastern Nigeria—presentation and challenges of care,” World Journal of Surgical Oncology, vol. 8, no. 1, pp. 73–79, 2010. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Skin Cancer Hindawi Publishing Corporation

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Hindawi Publishing Corporation
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Copyright © 2020 Bayaki Saka et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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10.1155/2020/2361957
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Abstract

Hindawi Journal of Skin Cancer Volume 2020, Article ID 2361957, 4 pages https://doi.org/10.1155/2020/2361957 Research Article A Histopathological Study of Skin Lesions in Individuals with Oculocutaneous Albinism in Togo in 2019 1 2 1 3 Bayaki Saka , Julienne Noude Teclessou , Sefako Abla Akakpo , Piham Gnossike, 4 5 6 1 Kwame´ Doh, Saliou Adam, Abas Mouhari-Toure, Garba Mahamadou, 1 7 8 2 Panawe´ Kassang, Yvette Elegbede Moise, Tchin Darre , Koussake Kombate, and Palokinam Pitche´ Service de Dermatologie et IST, CHU Sylvanus Olympio, Universit´e de Lom´e, Lom´e, Togo Service de Dermatologie et IST, CHU Campus Universit´e de Lom´e, Lom´e, Togo Centre National de Dermatologie de Gbossime´, Lome, Togo Unit´e D’histopathologie, Clinique M´elia, Lom´e, Togo Service de Chirurgie Maxillo-Faciale et Plastique, CHU Sylvanus Olympio, Universit´e de Lom´e, Lom´e, Togo Service de Dermatologie et IST, CHU Kara, Universite´ de Kara, Kara, Togo Service de Dermatologie et IST, Centre Hospitalier R´egional de Tomd`e, Kara, Togo Laboratoire D’anatomie et Cytotologie Pathologique, CHU Sylvanus Olympio, Universit´e de Lom´e, Lom´e, Togo Correspondence should be addressed to Julienne Noude Teclessou; tjulie06@yahoo.fr Received 6 May 2020; Accepted 9 July 2020; Published 29 July 2020 Academic Editor: Silvia Moretti Copyright © 2020 Bayaki Saka et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. *e aim of this study was to study the histopathological patterns of skin lesions in persons with albinism (PWA) in Togo in 2019. Method. During two mobile skin care clinics in 2019, biopsies/excisional biopsies were performed in PWA in case of clinical doubt or in front of lesions suspected to be cancerous for histological examination. Anatomopathological reports were thus analysed. Results. During the two mobile skin care clinics, 115 biopsies/excisional biopsies were carried out in 79 PWA, with a mean age of 24±16.1 years. Histological examination led to a diagnosis in 110 cases (95.6%) and was inconclusive in 5 cases (4 cases of uncertain histological diagnosis and one case of nonspecific histological lesions). Fourteen different histological diagnoses were made, with a frequency ranging from 0.9% (one case) to 26.9% (31 cases). *e four most frequent diagnoses in descending order were basal cell carcinomas (BCCs) (31 cases; 26.9%), invasive squamous cell carcinomas (SCCs) or Bowen’s disease (23 cases; 20%), keratosis (20 cases; 17.3%), and cysts (seven cases; 6.1%). *e 54 skin carcinomas were diagnosed in 33 (41.8%) of the 79 patients who underwent skin biopsies/excisional biopsies. *e BCC/SCC ratio was 1.3. No cases of cutaneous melanoma had been diagnosed. Conclusion. Skin cancers represent the main histological diagnosis in PWA (46.9%) in Togo in 2019. *e pattern of cutaneous malignancies in PWA shows the same trend as that seen in Caucasians with a predominance of basal cell carcinomas. risk of skin cancer [4–6]. *e diagnosis of skin diseases in 1. Introduction PWA very often requires histological examination [2, 7–9], Oculocutaneous albinism is an inherited disease charac- especially in the case of skin lesions suspected of being terized by the total or partial absence of melanin in the skin, cancerous. Indeed, the fear of the practitioner is the early hair, and eyes [1, 2]. Melanin, the pigment responsible for detection of these skin cancers in this population because of skin colour, is photoprotective against carcinogenic ultra- their very high frequency, varying from 23 to 26% depending violet radiation [3]. Its deficiency in people with albinism on the series [9–12]. We conducted this study in order to (PWA) predisposes them to the harmful effects of this ra- study the histopathological patterns of skin lesions in per- diation, with the development of actinic damage and a major sons with albinism (PWA) in Togo in 2019. 2 Journal of Skin Cancer in PWA is especially when skin lesions are suspected to be 2. Method malignant, as the practitioner’s obsession is the early de- Two rounds of free mobile skin care clinics took place tection of these skin cancers in this population because of throughout the Togolese territory in 2019 in order to treat their very high frequency [9–12]. In the series of Ene- malignant and premalignant lesions in PWA. *ese cam- chukwu et al. [9], skin biopsy was performed on suspicion paigns covered 10 cities in Togo, the first in June and July of premalignant or malignant lesions in 38% and 32% of 2019 and the second in October and November 2019. cases, respectively. Dermatological consultations were provided by a senior Histological examination resulted in a histological di- dermatologist. Biopsies/excisional biopsies were carried out agnosis of certainty in 110 (95.6%) of the 115 biopsies/ex- in case of clinical doubt or in front of lesions suspected of cisional biopsies in our study. In a French study on penile being malignant and sent to the laboratory of pathology of dermatosis in the general population [13], this histological the Sylvanus Olympio University Hospital or to the histo- examination led to a diagnosis in 85.5% of cases. Rajaratnam pathology unit of the Melia ´ clinic in Lome´ for histological et al. [14] in Ireland found in the study of general population examination. Two pathologists assisted in carrying out the that, in 55% of cases of inflammatory dermatosis, histology histological examinations. Anatomopathological reports led to a diagnosis of certainty, even without any clinical were collected and analysed. *e data collected were soci- information provided to the pathologist. *ese results show odemographic (age and sex) and histological diagnosis. the value of histology in dermatology for the diagnosis of skin diseases. In our study, 33 (41.8%) of the 79 patients who had 3. Results undergone biopsies/excisional biopsies had skin carcino- During these two campaigns, 115 biopsies/excisional bi- mas (BCCs in 26.9% of cases and invasive or in situ SCC in opsies were carried out for histological examination in 79 20% of cases). Other histological diagnoses were dominated patients, with an average of 1.5 biopsies/excisional biopsies by keratosis (17.3%), cysts (6.1%), hamartoma (6.2%), per PWA. Indeed, 24 of the 79 patients had more than one nodular folliculitis (6.1%), and benign squamous papillo- biopsy/excisional biopsy (15 had two biopsies/excisional mas (6.1%). In the series of Enechukwu et al. [9], 18 (60%) biopsies, 6 had three biopsies/excisional biopsies, and 3 had of the 30 patients biopsied had skin carcinomas including four biopsies/excisional biopsies). *e mean age of the 79 BCC (37.9%), SCC (15%), basosquamous carcinoma (12%), patients was 24±16.1 years (extremes: 7 and 75 years), and and collision tumour (BCC and SCC, 3.4%). Other his- the sex-ratio (M/F) was 1. All of these 115 biopsies were tological diagnoses were actinic keratosis (15%), nevi (12%), cutaneous. solar elastosis (1.2%), and psoriasis (1.7%). From these two Histological examination led to a diagnosis in 110 cases studies, premalignant and malignant dermatosis were (95.6%) and was inconclusive in 5 cases, including 4 cases of found to be the main histological diagnosis in PWA (46.9% uncertain histological diagnosis and 1 case of nonspecific in our series versus 83.3% in the Nigerian series [9]). *ese histological lesions. results confirm the impact of the sun, with a high preva- Fourteen different histological diagnoses were made, lence of actinic damage and skin cancer. Indeed, the ap- with a frequency ranging from 0.9% (one case) to 26.9% (31 pearance of actinic lesions in PWA is not only related to age cases). *e four most frequent diagnoses in descending [4, 10] but also and especially to the hot and sunny climate order were basal cell carcinomas (BCCs) (31 cases; 26.9%), [15, 16]. invasive squamous cell carcinomas (SCCs) or Bowen’s In our study, there was a predominance of BCC with a disease (23 cases; 20%), keratosis (20 cases; 17.3%), and cysts BCC/SCC ratio of 1.3. *is predominance could be (seven cases; 6.1%) (Table 1). *e 54 cutaneous carcinomas explained by the fact that, in our case, it is the dermatologist were diagnosed in 33 (41.8%) of the 79 patients who un- who goes to the PWA, which allows us to detect mild cases. derwent skin biopsies/excisional biopsies. *e BCC/SCC In Nigeria [9], BCC was also the most frequent skin car- ratio was 1.3. No cases of cutaneous melanoma had been cinoma (55%), followed by SCC (22%), basosquamous diagnosed. carcinoma (12%), and collision tumour (BCC and SCC, 3.4%). In Brazil [10], 62% were BCC, 51% were SCC, and 7% were melanoma. All three studies, including ours, were 4. Discussion population-based studies. However, most of the African studies, all hospital series, show that SCC is the most In our study, 115 biopsies/excisional biopsies were per- common cancer in this population [2, 17–19]. Finally, formed in 79 PWA, an average of 1.5 biopsies/excisional melanoma is rare in PWA with a similar incidence in the biopsies per PWA. *is rate is comparable to that found general population [10], a tumour that was not by us and (1.6 biopsies per PWA) in Tanzania where 134 biopsies Enechukwu et al. [9]. were performed on 86 PWA [2]. In Nigeria [9], 58 biopsies Limitations of study: the main limitation of this study is were taken from 30 PWA, corresponding to 1.9 PWA that histological examinations were performed by general biopsies. *ese results show that suspicious skin lesions pathologists and not dermatopathologists. Nevertheless, in requiring skin biopsy are most often multiple in the same 95.6% of cases, the histological examination made a PWA, probably due to the effects of ultraviolet radiation. diagnosis. Moreover, the main reason for biopsies/excisional biopsies Journal of Skin Cancer 3 Table 1: Histological diagnosis in PWA in Togo in 2019. Histological diagnostics Number (%) Basal cell carcinomas 31 26.9 Squamous cell carcinomas (in situ and invasive) 23 20.0 Keratosis 20 17.3 Cysts (epidermal, synovial, and sebaceous) 7 6.1 Hamartomes (folliculo-sebaceous, verruca sebaceous, and angiocrine) 6 5.2 Nodular folliculitis 6 5.2 Benign squamous papillomas 6 5.2 Hyperplastic fleshy buds 4 3.5 Lipomes 2 1.7 Plantar wart 1 0.9 Psoriasis 1 0.9 Supposedly benign round cell tumour 1 0.9 Ulcerated benign lobular hemangioma 1 0.9 Boil 1 0.9 Nonspecific skin ulceration 1 0.9 Histological diagnosis uncertain 4 3.5 Total 115 100 Actinic (2); benign (14); HPV/wart (4). 5. Conclusion Conflicts of Interest *e results of this study show that skin cancers represent the *e authors declare that they have no conflicts of interest. main histological diagnosis in PWA (46.9%) in Togo in 2019. *e pattern of cutaneous malignancies in PWA shows the Authors’ Contributions same trend as that seen in Caucasians with a predominance of basal cell carcinomas. *e popularization and respect of BS, PP, and GM were responsible for the conception of the photoprotection measures and systematic and regular ex- study, participated in the study design, undertook the field amination of the skin of these PWA will allow early detection study, conducted the data collection, analysis, and inter- and management of these skin cancers. pretation, and wrote the manuscript. *ey have revised and finalized the manuscript. JNT, PK, SA, SAK, PG, and YEM were involved in the data collection, analysis, and inter- Abbreviations pretation. *ey wrote and finalized the manuscript. AMT, ANAT: National association of albinos of Togo TD, and KK were involved in data analysis and interpre- BCC: Basal cell carcinoma tation. All the authors were responsible for the overall NGO: Nongovernmental organization scientific management of the study, for analysis and inter- PWA: Patients with albinism pretation, and the preparation of the final manuscript. Fi- SCC: Squamous cell carcinoma nally, all the authors read and approved the final manuscript SOTODERM: Togolese society of dermatology and sexually to be submitted for publication. transmitted infections UV: Ultraviolet. Acknowledgments Data Availability *e authors would like to thank the Pierre Fabre Foundation for fully funding this dermatological consultation project for Extracted data are with the authors and available for sharing people with albinism (PWA) in Togo. *e authors also thank on request. the National Association of Albinos of Togo (ANAT) for coordinating the PWA mobile clinics in 2019. 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Journal of Skin CancerHindawi Publishing Corporation

Published: Jul 29, 2020

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