title: Changing Trends of Skin Cancer: A Tertiary Care Hospital Study in Malwa Region of Punjab.
abstract: BACKGROUND
  Skin cancer constitutes a small but significant proportion of patients with cancer. Although the presence of eumelanin in dark skin is protective against the development of skin cancer, it is increasingly being diagnosed in the Indian population.
  
  
  OBJECTIVE
  To study the profile of skin cancer patients presenting to a tertiary hospital in Malwa area of Punjab, India.
  
  
  METHODS
  Retrospective study was done to analyse the profile of skin cancer patients who attended the institution over one year from 1(st) December 2013 to 30(th) November 2014. A comprehensive review of aetiology and related risk factors was done to correlate the environmental factors with high skin cancer prevalence in this region.
  
  
  RESULTS
  Skin cancer constituted (3.18%) 84 out of 2638 patients registered with cancer of all types. The age of the patients was 62±14.2 years and ranged from 27 to 92 yrs. Basal cell carcinoma (BCC) was the most common histological type(46/84, 54.76%) followed by squamous cell carcinoma (SCC) (31/84, 36.91%) and malignant melanoma (MM) (7/84, 8.33%). Male: female ratio was found to be 0.79:1. BCC showed higher female preponderance (p<0.05). Head and Neck was the commonest site involved (p<0.05). Majority (88%) of patients were from rural area. 92% of patients were directly into the profession of agriculture with history of prolonged exposure to sunlight.
  
  
  CONCLUSIONS
  Skin cancer constitutes a small but significant proportion of patients with cancers. This study highlights a paradoxically increasing trend of BCC and female preponderance. Head and neck is the most common site involved. Exposure to Ultra Violet B (UVB) radiation and higher levels of arsenic in drinking water has been reported to be associated with skin cancers. Limited studies show that levels of arsenic and pesticides were higher in the samples of drinking water in Malwa area of Punjab. Therefore a multipronged strategy to provide safe drinking water supply and discouraging the indiscriminate use of pesticides is recommended.
authors: Assistant Professor, Department of Plastic Surgery, GGS Medical College and Hospital , Faridkot, Punjab, India .
authors: Sonal Tina
authors: ST
authors: Lal
authors: Associate Professor, Department of Radiotherapy, GGS Medical College and Hospital , Faridkot, Punjab, India .
authors: Raja Paramjeet Singh
authors: RP
authors: Banipal
authors: Professor and Head, Department of Plastic Surgery, GGS Medical College and Hospital , Faridkot, Punjab, India .
authors: Deepak John
authors: DJ
authors: Bhatti
authors: Professor and Head, Department of Radiotherapy, GGS Medical College and Hospital , Faridkot, Punjab, India .
authors: Hanuman Prasad
authors: HP
authors: Yadav
keywords: Arsenic; Basal cell carcinoma; Skin cancer; Ultraviolet radiation