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
Letter to the Editor
2017:83:3;363-365
doi: 10.4103/0378-6323.201339
PMID: 28272060

Squamous cell carcinoma in long-standing chromoblastomycosis

Prasenjeet Mohanty, K Vivekanandh, Liza Mohapatra, Gaurav Dash
 Department of Skin and VD, SCBMCH, Cuttack, Odisha, India

Correspondence Address:
K Vivekanandh
Room No. 201, Metro Manorama Complex, Kathagola Road, Mangalabag, Cuttack - 753 001, Odisha
India
How to cite this article:
Mohanty P, Vivekanandh K, Mohapatra L, Dash G. Squamous cell carcinoma in long-standing chromoblastomycosis. Indian J Dermatol Venereol Leprol 2017;83:363-365
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Chromoblastomycosis is a slowly progressive mycosis affecting the skin and subcutaneous tissue.[1] It is caused by dematiaceous, naturally pigmented fungi, which exist as saprophytes in the soil and in decaying vegetation. Common etiologic agents are Cladophialophora carrionii and Fonsecaea pedrosoi.[2] The definite incidence is not known, as there are only sporadic reports in literature.[1] It usually occurs after penetrative trauma with vegetative matter and affects middle-aged male agricultural workers, usually, of the tropical and subtropical regions of the world. Long-standing cases can rarely undergo malignant change.[1],[2]

A 70-year-old male farmer presented with an asymptomatic atrophic crusted plaque, covering the entire dorsum of the left foot for the past 15 years. On examination, the non-tender plaque was approximately 10 cm × 12 cm in size, with black to brownish dots on a yellowish crusted surface with variable atrophy and depigmentation at most places [Figure - 1]. He, initially, had a nodule of about 0.5 cm2 size, which gradually progressed to the present size and was not associated with any constitutional features. The patient was otherwise well. He could not recall any history of trauma. Clinically, the differential diagnoses of chromoblastomycosis and lupus vulgaris were considered. Routine investigations were normal. Potassium hydroxide mount showed sclerotic bodies. Histopathology showed pseudoepitheliomatous hyperplasia, suppurative granulomas and sclerotic bodies, which was consistent with chromoblastomycosis [Figure - 2]. Fungal culture with lactophenol cotton blue preparation showed septate fungal hyphae with acropetal long chains of conidia suggestive of Cladosporium carrionii.

Figure 1: Pretreatment picture showing single atrophic, crusted plaque over left foot
Figure 2: Sclerotic bodies (arrow) (H and E, ×400)

The patient was then treated with terbinafine 250 mg, one tablet twice daily and local heat therapy by applying hot water bag 2–3 times a day for 6 months. There was a significant decrease in size, verrucosity and clearing of the dots; however, in one part of the lesion, there was no improvement. Rather, there was a gradual development of an ulcer of size 10 cm × 7 cm with ill-defined margins, everted edges, a floor of poor granulation tissue, indurated base and normal surrounding skin with no evidence of any discharge or regional lymphadenopathy [Figure - 3]. As there was progression of the ulcer after 6 months of therapy, we suspected a malignancy and did an incisional biopsy which showed malignant squamous cells arranged in sheets and nests, infiltrating into the dermis, with pleomorphic cells with high nuclear-cytoplasmic ratio, keratin pearls and inflammatory cells in the background, consistent with squamous cell carcinoma [Figure - 4]. The patient was referred to oncosurgery department, where he was advised to undergo excision, after which the patient was lost to follow-up.

Figure 3: Ulcer with everted edges over the plaque after 6 months of treatment
Figure 4: Malignant squamous cells infiltrating into dermis (H and E, ×100)

Chromoblastomycosis is a chronic granulomatous infection, usually of exposed areas. It usually presents as warty plaques, nodules or cauliflower-like growths. Six clinical variants have been identified: Nodular, verrucous or vegetative (53%), tumoral, plaque (41%), psoriasiform, cicatricial and elephantiasic; in addition to occasional other, atypical forms.[1] Infection occurs due to the introduction of organisms into tissues by a wooden splinter or abrasion of skin. In histologic sections, fungi are visible as dark brown, thick-walled spherical bodies of 5–15 μm diameter (sclerotic bodies).[3] Complications include hematogenous spread, secondary infection and rarely malignancy.[1] Malignancy is insidious in onset, arising between 20 and 30 years from the acquisition of infection. There have been reports that the presence of chronic inflammation and scarring may predispose to squamous cell carcinoma.[1] Limbs are most commonly affected by malignant transformation, as it is a common site for chromoblastomycosis.[2] In one study carried out in Brazil, among 100 patients who had chromoblastomycosis over a mean duration of 14 years, two patients developed squamous cell carcinoma. In a case report by Torres et al., malignancy developed after 30 years of the disease.[1] In another study carried out in Madagascar, malignant transformation was reported in 14 out of 1400 cases over 50 years. Only 17 such cases have been documented worldwide.[1] It is usually treated with itraconazole 200–400 mg/day or terbinafine 250–500 mg/day for a mean period of 6–12 months. In a study by Esterre et al., 6–12 months of terbinafine at a dosage of 500 mg/day was administered orally to 43 patients, with a diagnosis of chromomycosis. Mycological cure, as judged by skin scrapings, was observed in 41.4%, 74.1% and 82.5% of patients infected with F. pedrosoi after 4, 8 and 12 months of therapy, respectively. The efficacy of terbinafine in C. carrionii infected patients seemed even higher.[4] Other drugs include potassium iodide, amphotericin B, fluconazole and 5-fluorocytosine. Excision, cryosurgery, local heat therapy, curettage with electrodesiccation and laser are used as adjuncts to antifungals. In advanced cases, a combination of medical and surgical treatment is recommended.[2]

In our case, the patient had the lesion for 15 years, on the dorsum of the left foot. After treatment, there was a good response in one side of the lesion while the other side developed ulceration and squamous cell carcinoma. One has to suspect malignancy in the case of any suspicious change in the morphology of long-standing lesions, such as the development of ulceration or growth, along with poor response to treatment. High index of suspicion and early histological diagnosis helps in preventing complications. We found only one case previously reported in India.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Torres E, Beristain JG, Lievanos Z, Arenas R. Chromoblastomycosis associated with a lethal squamous cell carcinoma. An Bras Dermatol 2010;85:267-70.
[Google Scholar]
2.
Jamil A, Lee YY, Thevarajah S. Invasive squamous cell carcinoma arising from chromoblastomycosis. Med Mycol 2012;50:99-102.
[Google Scholar]
3.
Mittal A, Agarwal N, Gupta LK, Khare AK. Chromoblastomycosis from a non-endemic area and response to itraconazole. Indian J Dermatol 2014;59:606-8.
[Google Scholar]
4.
Esterre P, Inzan CK, Ramarcel ER, Andriantsimahavandy A, Ratsioharana M, Pecarrere JL, et al. Treatment of chromomycosis with terbinafine: Preliminary results of an open pilot study. Br J Dermatol 1996;134 Suppl 46:33-6.
[Google Scholar]
5.
Jacob M, Mathal R, Prasad P, Bhaktaviziam A. Chromoblastomycosis with squamous cell carcinoma. Indian J Dermatol Venereol Leprol 1988;54:314-7.
[Google Scholar]

Fulltext Views
151

PDF downloads
88
Show Sections