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   Abstract
   Introduction
   Case Report
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CASE REPORT
Year : 1994  |  Volume : 60  |  Issue : 2  |  Page : 117-119

Squamous cell carcinoma arising from morphoea




Correspondence Address:
G Anandan


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Source of Support: None, Conflict of Interest: None


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  Abstract 

A case of squamous cell carcinoma arising from morphoea in a 45 year old male is presented. The diagnosis of morphoea and squamous cell carcinoma was confirmed by histopathological examination. To our knowledge this is the first such case to be reported in literature.


Keywords: Morphoea, Squamous cell carcinoma


How to cite this article:
Anandan G, Jayakumar J, Aschoff M, Kurian S, Job C. Squamous cell carcinoma arising from morphoea. Indian J Dermatol Venereol Leprol 1994;60:117-9

How to cite this URL:
Anandan G, Jayakumar J, Aschoff M, Kurian S, Job C. Squamous cell carcinoma arising from morphoea. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Dec 9];60:117-9. Available from: http://www.ijdvl.com/text.asp?1994/60/2/117/4014



  Introduction Top


Squamous cell carcinoma rarely if ever occurs in normal skin, but usually arises from skin damaged by actinic rays. [1] Exposure to chemicals like coal tar, arsenic, soot and a variety of oils and distillation products were also causes for squamous cell carcinoma. [2] It occasionally occurs in scars following inflammatory or degenerative processes. In this communication we record a case of squamous cell carcinoma arising from morphoea.


  Case Report Top


A 45-year-old male patient reported with a complaint of having a chronic ulcer in the left anterior chest wall gradually increasing in size for 2 to 3 months. He also complained of a large hyperpigmented patch involving the anterior chest wall extending on to the back which was diagnosed as morphoea in 1981 and was treated with chloroquine tablets and vitamin B complex capsules for 12 years. From 2 to 3 months back he developed itchy sensation in a localized area at the left anterior chest wall just below the nipple over the previously diagnosed lesion of morphoea. He used to scratch this area off and on and it got ulcerated. This ulcer was small to start with and it gradually increased in size. According to the patient it was treated with oral drugs and various dressings over the last 2 months. Instead of healing the ulcer became worse and he noticed small nodular lesions at the base of the ulcer.

On examination the patient had several large and small brownish black lesions which had many scattered depigmented areas. One lesion was over the left lower part of the anterior chest wall extending on to the abdomen, to the inguinal region and also to the back. The skin over the lesion was tight and had a smooth surface. He had another 5 much smaller lesions of similar appearance in the right axilla [Figure - 1], right forearm, left axilla, left groin and left thigh. The large skin patch over the chest wall had an irregular configuration. At the edge of this lesion on the anterior chest wall just below the nipple there was a irregular ulcer measuring 5cm x 4 cm [Figure - 2]. The margin of the ulcer was slightly indurated. The base of the 'ulcer had small elevations giving a cauliflower-like appearance. A biopsy of the ulcer was done. A biopsy of the skin lesion was also done to confirm the diagnosis of morphoea. Routine blood examination showed the following results.

Haemoglobin was 16.8%. Total white blood cell count was 8600/cmm. Differential count was normal. Chest X-ray was normal.

The biopsy from the skin lesion showed epidermis with flattening of the rete ridges. In the dermis the significant finding was the complete absence of skin adnexa and homogenization of the dermal collagen [Figure - 3]. The reticular dermis was thickened and stained deeply eosinophilic. The subcutaneous tissue was almost completely replaced by collagen. This histopathological appearance confirms the diagnosis of late stage of morphoea.

The biopsy of the ulcer showed irregular proliferation of stratified squamous epithelium. There was dyskeratosis, marked pleomorphism of the epithelium and invasion of the deeper tissue with malignant epithelial cells [Figure - 4]. Some reactive fibrosis was present. There was paucity of inflammatory changes. The lesion was diagnosed as squamous cell carcinoma. The patient was referred to a cancer hospital for further treatment.


  Comments Top


Squamous cell carcinoma of the skin usually presents clinically as a shallow ulcer with an elevated indurated border. In this case the edge was only slightly indurated there was no elevation of the border. The middle of the ulcer was raised, granular and had a cauliflower-like appearance. Clinically the lesion looked like a chronic ulcer with exuberant granulation tissue and there was no suspicion of cancer. Biopsy examination revealed a moderately well differentiated squamous cell carcinoma.

There are reports of cases in which squamous cell carcinoma had arisen from cutaneous scars from burns,[2] X-rays [3] and sinuses of chronic osteomyelitis. [4] Recently squamous cell carcinoma associated with chronic plantar ulcers in leprosy had been reported. [5],[6] In this instance the patient had cutaneous scars following morphoea for 12 years. The patient felt itchy and scratched the area often. It is reasonable to suggest that the etiopathogenesis of malignant transformation of the epithelium in this case could be same as in other instances where scarring and chronic irritation had produced squamous cell carcinoma. [2],[3],[4]


  Acknowledgement Top


We are grateful to the American Leprosy Missions Inc., for their financial support and to Mr N Baskar for secretarial assistance.

 
  References Top

1.Lever WF, Schaumburg-Lever G. In Histopathology of skin, 7th edn. Philadelphia JB Lippincott, 1990; 552.  Back to cited text no. 1    
2.Rosai J. Ackerman's surgical pathology, 7th edn.New Delhi : Jaypee Brothers, 1990; 92-3.  Back to cited text no. 2    
3.Martin H, Strong C, Spiro RH. Radiation induced skin cancer of the head and neck. Cancer 1970 : 25 : 61-71.  Back to cited text no. 3    
4.Johnson LL, Kempson RL. Epidermoid carcinoma in chronic osteomyelitis. Diagnostic problems and Management. J Bone joint Surg 1965; 47 : 133-45.  Back to cited text no. 4  [PUBMED]  
5.Job CK, Riedal RG. Squamous cell carcinoma arising in plantar ulcers in leprosy. Int J Lepr 1946; 32 : 37-44.  Back to cited text no. 5    
6.Girdhar M, Mohan L, Arora SK, et al. Squamous cell carcinoma developing in ulcers of leprosy - Report of 2 cases. Ind J Lepr 1990; 62 : 126-8.  Back to cited text no. 6  [PUBMED]  


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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