Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Net Letter
2020:86:4;469-469
doi: 10.4103/ijdvl.IJDVL_769_18
PMID: 31710000

Multiple inguinal basal cell carcinomas in the setting of intertrigo

Alexander Brooks Aria1 , Lara E Rosenbaum2 , Michael R Migden2
1 Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA
2 Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence Address:
Michael R Migden
Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1452, Houston, Texas 77030
USA
Published: 08-Nov-2019
How to cite this article:
Aria AB, Rosenbaum LE, Migden MR. Multiple inguinal basal cell carcinomas in the setting of intertrigo. Indian J Dermatol Venereol Leprol 2020;86:469
Copyright: (C)2020 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Genital basal cell carcinoma is an uncommon entity, which may be triggered by certain factors like poor hygiene, longstanding local skin irritation or previous radiotherapy. We present an interesting case of multiple basal cell carcinomas involving the left groin in the setting of intertrigo.

A 72-year-old male presented to his dermatologist with a discrete pearly telangiectatic papule in the left inguinal fold within a background area clinically consistent with intertrigo. The patient had a history of two basal cell carcinomas on the face removed 8–10 years ago and a 1-year history of intertrigo in the left inguinal fold treated with clotrimazole–betamethasone. Biopsy of the discrete pearly papule revealed basal cell carcinoma. He then developed two new biopsy-proven lesions adjacent to the original basal cell carcinoma. Due to concern for locoregional metastasis, he was referred to our clinic for further evaluation.

There was no relevant family history or clinical evidence to suggest a genetic disorder, such as basal cell nevus syndrome. Physical examination revealed a 3.2 × 2.0 cm pink, scaly, thin plaque in the left groin along with a 1.0 × 0.8 cm pink, scaly plaque located distally and a 1.6 × 0.8 cm pink plaque located proximally. Inguinal lymph nodes were non palpable. A computed tomography scan also ruled out pathologically enlarged lymph nodes.

We performed Mohs micrographic surgery for all the lesions, as metastasis was not evident. Histopathologic findings of all lesions demonstrated atypical aggregates of basaloid cells, consistent with the diagnosis of basal cell carcinoma [Figure - 1]. At the time of surgery, background erythema with mild scale was noted in the left inguinal fold on opposing surfaces suggestive of intertrigo [Figure - 2]. We performed surgical excision along with tissue repair for all the lesions, which healed satisfactorily within 1 month. The patient was started on topical ketoconazole (antifungal agent) in the groin to treat his persistent intertrigo [Figure - 3]. Seven weeks later (about 3 months after surgery), we observed complete healing of the surgical areas along with clearing of the intertrigo [Figure - 4].

Figure 1:
Figure 2: Three basal cell carcinomas outlined with a skin-marking pen in the left inguinal fold. Surrounding erythema and mild scale were noted in a kissing distribution in the inguinal fold
Figure 3: One month after surgery, the area was healing well. Significant erythema, scale, and satellite pink macules again in a kissing distribution in the left inguinal fold were noted
Figure 4: Three months after surgery, the patient's surgical sites were well-healed and his intertrigo had cleared with the use of three times per week ketoconazole shampoo

Sun-protected areas of the body rarely develop basal cell carcinoma and its etiology in such anatomic locations is unclear. Betti et al. evaluated 3254 consecutive basal cell carcinomas and found head and neck to be the most common site [1766 (54.3%)], followed by trunk [1113 (34.2%)] limbs [362 (11.1%)] and genitalia [13 (11.1%)].[1] Our patient's risk factors included age, prior history of basal cell carcinoma on the face, and possibly chronic skin inflammation due to intertrigo. It has been suggested that local factors like concave shape, reduced skin tension, and skin folds favour the development of basal cell carcinoma in sun-protected areas like axillae and groin (as in our case).[2],[3] Heckmann et al. concluded that reduced dermal thickness, altered connective tissue arrangements, altered expression of metalloproteinases, and reduced numbers of integrins at these sites may also contribute to the development of this disorder.[2]

Intertrigo is an inflammatory condition most commonly due to a Candida infection and which involves skin folds such as the inguinal folds, axillae, intergluteal folds, and scrotum. It can be speculated that pre-existing intertrigo in our patient could have increased the risk of basal cell carcinoma in a sun-protected area due to chronic local skin inflammation and irritation. Hau et al. reported Candida albicans induced robust activation of T-helper 17 cells, resulting in increased release of interleukin (IL)-17 and IL-22.[4]

Nardinocchi et al. demonstrated a high infiltration of IL-17 + and IL-22 + T-cells in basal cell carcinomas.[5] IL-17 and IL-22 also increased proliferation and migration of the basal cell carcinoma cell line M77015 in anin vitro study.[5] Several reports suggest that IL-17 upregulates nuclear factor kappa light chain enhancer of activated B cells' (NFκB) signaling and IL-22 activates the signal transducer and activator of transcription 3 (STAT3) pathway, which are molecular signaling pathways known to promote carcinogenesis of basal cell carcinoma.[5],[6]

Based on these data, we suggest that Candidal intertrigo led to increased levels of IL-17 and IL-22 in our patient's inguinal area through a natural immune response, thus creating an inflammatory microenvironment favorable for basal cell carcinoma development. However, this proposed relationship warrants further investigation and study. To conclude, physicians should be aware of potential risk factors which may modify a patient's immune profile, altering their risk for developing basal cell carcinoma in sun-protected areas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Betti R, Radaelli G, Bombonato C, Crosti C, Cerri A, Menni S. Anatomic location of basal cell carcinomas may favor certain histologic subtypes. J Cutan Med Surg 2010;14:298-302.
[Google Scholar]
2.
Heckmann M, Zogelmeier F, Konz B. Frequency of facial basal cell carcinoma does not correlate with site-specific UV exposure. Arch Dermatol 2002;138:1494-7.
[Google Scholar]
3.
LeSueur BW, DiCaudo DJ, Connolly SM. Axillary basal cell carcinoma. Dermatol Surg 2003;29:1105-8.
[Google Scholar]
4.
Hau CS, Tada Y, Kanda N, Watanabe S. Immunoresponses in dermatomycoses. J Dermatol 2015;42:236-44.
[Google Scholar]
5.
Nardinocchi L, Sonego G, Passarelli F, Avitabile S, Scarponi C, Failla CM, et al. Interleukin-17 and interleukin-22 promote tumor progression in human nonmelanoma skin cancer. Eur J Immunol 2015;45:922-31.
[Google Scholar]
6.
Feehan RP, Shantz LM. Molecular signaling cascades involved in nonmelanoma skin carcinogenesis. Biochem J 2016;473:2973-94.
[Google Scholar]

Fulltext Views
194

PDF downloads
80
Show Sections