title: A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia.
abstract: BACKGROUND
  Nonmelanoma skin cancer (NMSC) comprises a heterogeneous group of cancers. A comprehensive review of NMSC mortality has not been performed previously in this region.
  
  
  OBJECTIVE
  We sought to document the population affected by lethal NMSC, the types of tumors involved, and their histopathologic features.
  
  
  METHODS
  Death certificates of all patients who died from NMSC were examined. Histology of the primary lesion was reviewed in cases when the primary lesion was identified and sections were available.
  
  
  RESULTS
  A total of 120 NMSC deaths occurred, including 89 caused by squamous cell carcinoma, 22 by Merkel cell carcinoma, and 9 others. The median age at death was 79 years, unless the patients were immune deficient (68 years). When the primary lesion was identified (n = 45), the median survival after diagnosis was 17 months; 75% of patients died within 3 years. Lethal neoplasms were deeply invasive and infiltrated into the reticular dermis and beyond. Three squamous cell carcinomas were reclassified as adenosquamous carcinoma.
  
  
  CONCLUSIONS
  Lethal NMSC occurs in the elderly and consists mainly of 3 types of deeply invasive cancers.
authors.affiliation: Department of Anatomical Pathology, Nedlands and Fremantle.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Nolan
authors.forename: Madelynn T-L
authors.initials: MT
authors.lastname: Chan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Heenan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000473:pathology; D015266:Carcinoma, Merkel Cell / Q000401:mortality / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis; D014904:Western Australia / Q000453:epidemiology