上海市某社区老年人皮肤肿瘤流行病学研究

Epidemiological study of elderly skin tumors in a community in Shanghai

目的获取上海市社区老年人群皮肤肿瘤的患病情况及危险因素资料，为皮肤恶性肿瘤的早期发现、早期诊断、早期治疗提供参考数据。方法2011年5月1日-11月30只期间采用整群抽样法对上海市长宁区北新泾街道60岁以上常住居民进行问卷调查及皮肤科检查，并对可疑皮损行病理检查明确诊断。分类统计皮肤肿瘤患病情况并分析危险因素。结果1、在2043例资料完整的居民中，良性肿瘤中脂溢性角化患病率为100％。其他良性皮肤肿瘤（包括角化棘皮瘤、皮角、日光胶原病）16例（0．78％）。经病理明确诊断的皮肤恶性肿瘤共计76例，其中日光性角化病患病率最高，总计63例（3．07％），此外鳞状细胞癌3例（0．15％），基底细胞癌9例（0．44％），鲍恩病1例（0．05％）；上述病种的患病率随年龄增长而增加，高峰年龄为75岁以上；2、所有皮肤恶性肿瘤发生部位频率最高为头面颈部，总计有62例（占总病例数67．39％），其中R光性角化病及基底细胞癌发生于头面颈的比率最高；3、所有95例可疑皮损中，临床与病理诊断符合病例数为76例（80％）；4、人群中以Ⅳ型皮肤为主，约占68．4％（1398例），其中Ⅲ型皮肤人群中皮肤肿瘤的患病率最高（P〈0．05）；5、长期紫外线曝露者发生皮肤恶性肿瘤的概率较高（P〈0．05）。结论上海市社区老年人群中皮肤肿瘤的发生率随年龄增长，主要为非黑素瘤性皮肤癌，好发于头面颈部，这可能与人口老龄化、强紫外线、浅肤色等因素有一定关系。加强宣教，避免日晒和光防护是重要的干预措施。

Objective To investigate the prevalence and associated risk factors of skin cancers in Shanghai through a community-based survey. Methods Between 4May and November 2011, a community-wide skin cancer screening was conducted among residents over 60 years using a cluster sampling survey with questionnaires and dermatological examina-tions. Results 2 043 residents were surveyed. Seborrheic keratosis was observed in all residents with benign tumors. Other benign diseases were keratoacanthoma, cutaneous horn and actinic collagen diseases （16 cases, 0.78%）. Among 76 cases of pathologically proven malignant lesions, actinic keratosis （AK） had the highest prevalence （3.07%）, followed by basal cell carcinoma （BCC, 0.44%）, squamous cell carcinoma （0.15%）, and Bowen disease （0.05%）. Regarding an atomical distribution, 67.39% of malignant lesions occurred in head and neck region, dominated by AK and BCC. Among 95 suspected lesions, the accordance rate between clinical diagnosis and pathological findings was up to 80%. The most common skin type was type IV in this surveyed population. However, residents with type Ⅲ skin had the highest prevalence of skin cancer （P〈 0.05）. Long term UV exposure correlated with higher incidence of non-melanoma skin cancer （P〈 0.05）. Conclusions This study showed that the prevalence of non-melanoma skin cancer increased with aging in Shanghai and head and neck region was the prevalent site. Aging, ultraviolet exposure and light skin could be the contributing factors.