Clinical Patterns and Disease Burden of Cutaneous Squamous Cell Carcinoma in a Multiethnic Malaysian Cohort: A Multicenter Study

Abstract

Background: Cutaneous squamous cell carcinoma (CSCC) is an aggressive malignancy with limited epidemiological data available for Asian populations. This study aimed to analyse clinical patterns, risk factors, and disease burden within a multicentre Malaysian cohort.

Methods: A retrospective cohort study was conducted across 12 hospitals (nine public and three university-based) between 2013 and 2019, including 229 patients. Univariate and multivariate Cox regression models were employed to identify predictors of recurrence. Disability-adjusted life years (DALY) were calculated to estimate the overall disease burden.

Results: The mean patient age was 67 years (SD = 15.14). A male predominance was observed at 69.9%. While Malay patients constituted 52.8% of the cohort, Chinese patients (38.4%) were disproportionately represented relative to national demographics. Advanced presentation was prevalent, with a mean lesion duration of 21.4 months. Significant independent predictors of early recurrence in the multivariate model were tumour thickness (HR = 1.25; 95% CI: 1.03, 1.50) and lymphovascular invasion (HR = 33.68; 95% CI: 2.02, 561.24). The estimated DALY was 5.135 years per patient.

Conclusion: In Malaysia, CSCC frequently presents at advanced stages with unique ethnic distributions. High DALY values and aggressive clinicopathological features underscore the urgent need for early detection programmes and tailored management strategies for Asian skin types.