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 in Response to Previous Publication
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
Residents' Page
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
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
2011:77:2;253-253
doi: 10.4103/0378-6323.77493
PMID: 21393979

Squamous cell carcinoma arising from radiation-treated lupus vulgaris scar

Magdalena Kiedrowicz1 , Andrzej Krlicki1 , Bielecka-Grzela Stanislawa2 , Romuald Maleszka1
1 Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
2 Division of Aesthetic Dermatology, Pomeranian Medical University, Szczecin, Poland

Correspondence Address:
Magdalena Kiedrowicz
Department of Skin and Venereal Diseases, Pomeranian Medical University, 72, Powstancow Wlkp. St., 70-111 Szczecin
Poland
How to cite this article:
Kiedrowicz M, Krlicki A, Stanislawa BG, Maleszka R. Squamous cell carcinoma arising from radiation-treated lupus vulgaris scar. Indian J Dermatol Venereol Leprol 2011;77:253
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis worldwide. It usually appears in immunocompetent patients as a result of hematogenous, lymphatic or contiguous spreading of bacilli from noncutaneous foci of infection. [1],[2] Skin lesions are usually slow-growing, primarily represented by red-brown nodules, showing an apple-jelly-colored finding in diascopic examination. [2] LV represents a chronic and progressive skin condition, which, if untreated, leads to complications, including scars, ulcerations, local deformations and skin cancers. [1] The majority of these cancers are squamous cell carcinomas (SCCs), known as lupus carcinomas. [3] Two clinical types of lupus carcinomas have been singled out: cancers developing within tissues of active tuberculosis; and, in prevailing cases, tumors arising from old post-tuberculous scars. [2],[4]

A 73-year-old male patient presented to our department in 2009 with a 4-year history of a slowly growing, large, 3 cm in diameter, exophytic, verrucous and hyperkeratotic tumor on the lateral side of the neck. It had developed on an area of a porcelain-white, atrophic scar with a poorly defined margin, that had been present since 1997 [[Figure - 1]a]. At the time of hospitalization, he was otherwise in good health, and the local lymph nodes in the cervical and submandibular region were not palpated. The past medical history of this patient included lupus vulgaris in the mentioned location. The initial symptoms of cutaneous tuberculosis had appeared 64 years ago as reddish-brown nodules. In the meantime, in the 60s of the 20 th century, a trial of radiation therapy was performed, but without any effect. The final diagnosis was established in 1997 on the basis of a clinical examination (well-demarked, brownish-red, infiltrated plaque with peripheral nodules and apple-jelly color on diascopic examination) [Figure - 2], histopathological picture and adequate response to antituberculous agents (isoniazid, rifampicin and ethambutol administered for a period of 9 months). After antituberculous treatment, erythematous plaque regressed, leaving an atrophic scar.

Figure 1: (a) Squamous cell carcinoma arising from posttuberculous scar on the neck (dermatological picture in 2009). (b) Histopathological examination of excised tumor showing verrucous carcinoma with deeply penetrating nests of malignant cells surrounded by infiltrate of lymphocytes and plasmac cells (H and E, ×200)
Figure 2: Lupus vulgaris on the neck (dermatological picture in 1997)

The tumor lesion on the neck was excised under local anesthesia along with some of the scar tissues around its location to reduce the chance of recurrence. Histopathological examination revealed verrucous carcinoma (VC), an uncommon variant of SCC, exhibiting an endophytic growth pattern with deeply penetrating nests of malignant cells surrounded by inflammatory infiltrate of lymphocytes and plasmatic cells [[Figure - 1]b]. Biopsy of the surrounding scar tissue showed no features typical for active tuberculosis. Dissection of the regional lymph nodes was not performed, as there was no evidence of their involvement in both clinical and ultrasound examination. The chest X-ray examination was unremarkable. In an 18-month follow-up evaluation, neither local recurrence nor regional lymphadenopathy was noticed. The patient remains under close medical follow-up due to the potential risk of metastases of VC; however, the incidence of such a complication in this histopathological type of SCC is minimal.

SCC is one of the most common tumors complicating the course of persistent LV. The incidence of SCC developing within lesions of this form of cutaneous tuberculosis accounts for 0.5% to 10.5% of cases. [2] The time interval of development of lupus vulgaris to the neoplasmatic transformation may last even up to 79 years. [2] The pathogenesis of SCC induction process in chronic lupus vulgaris lesions and post-tuberculosis scars has not been clearly defined. The suggested triggering factors include prolonged infiltration of inflammatory cells producing mutagenic free oxygen radicals, protracted irritation, ultraviolet irradiation exposure and radiation therapy. [1],[3] Radiotherapy appeared to be the most strongly associated risk factor in some SCC case series. [3]

In the presented case, histopathological examination of excised tumor confirmed the diagnosis of VC, which refers to a locally aggressive, clinically exophytic, low-grade, well-differentiated clinicopathologic form of SCC with a very low incidence of metastasis. [5] Persistent inflammatory diseases have been mentioned as important factor playing a role in the pathogenesis of VC. [5] Therefore, persistent irritation and inflammation in LV lesions in association with chronic sun exposure and radiotherapy damage might have initiated neoplasmatic transformation in the presented case.

Although it has been underlined that SCCs complicating LV usually arise on atrophic scars, most of the published reports focus on the tumors developing within lesions of active cutaneous tuberculosis. [1],[2] A Medline-based literature search has revealed only a limited number of SCC cases connected with definitive post-tuberculous scar, as it was observed in our patient. [4]

Despite the current rarity of lupus vulgaris and its complication in the form of cutaneous cancers, the presented case strongly suggests the actuality of the problem; therefore, dermatologists should pay attention to the possibility of its existence.

References
1.
Gooptu C, Marks N, Thomas J, James MP. Squamous cell carcinoma associated with lupus vulgaris. Clin Exp Dermatol 1998;23:99-102.
[Google Scholar]
2.
Motswaledi MH, Doman C. Lupus vulgaris with squamous cell carcinoma. J Cutan Pathol 2007;34:939-41.
[Google Scholar]
3.
Förström L. Carcinomatous changes in lupus vulgaris. Ann Clin Res 1969;1:213-9.
[Google Scholar]
4.
May SB. Squamous cell carcinoma in old radiation treated lupus vulgaris scar on neck. Arch Dermatol 1969;100:509-10.
[Google Scholar]
5.
Assaf C, Steinhoff M, Petrov I, Geilen CC, de Villiers EM, Schultz-Ehrenburg U, et al. Verrucous carcinoma of the axilla: case report and review. J Cutan Pathol 2004;31:199-204.
[Google Scholar]

Fulltext Views
126

PDF downloads
94
Show Sections