|Year : 2000 | Volume
| Issue : 5 | Page : 270-271
Squamous cell carcinoma arising from Gumma
K Pavithran, Najeeba Riyaz
Source of Support: None, Conflict of Interest: None
Syphilitic gumma is now rare to be seen. Squamous cell carcinoma arising from gumma is still more rare. We report a case of gumma in which squamous cell carcinoma developed.
Keywords: Gumma, Squamous cell carcinoma, Carcinoma
|How to cite this article:|
Pavithran K, Riyaz N. Squamous cell carcinoma arising from Gumma. Indian J Dermatol Venereol Leprol 2000;66:270-1
| Introduction|| |
Gumma is the characteristic lesion of tertiary syphilis which may manifest 230 years after the primary.  It is a deep granulomatous process which begins as a subcutaneous nodule later breaking down to a punched out ulcer with 'washleather' granulation tissue and heal with tissue paper scar. Rarely squamous cell carcinoma can arise in such lesions. We report such a case.
| Case Report|| |
A 50-year-old man was seen with a painless non-healing ulcer of the left shin of 4 years duration. It started as a nodule which broke down to form an ulcer. He gave history of a genital ulcer following extramarital sexual exposure 20 years back.
Examination revealed a punched out ulcer of size 5 X 3 cms with surrounding irregular hyperkeratosis on the left shin [Figure - 1]. Multiple ill defined 'tissue paper' scars were seen around the ulcer. No bone thickening was observed around the ulcer. Another keratotic plaque with horny projection was seen on the (L) elbow in the vicinity of a scar [Figure - 2].
Systemic examination was normal. Investigations revealed a reactive blood VDRL (1/8) and positive TPHA (1/320). ELISA for HIV was negative. Skin biopsy was consistent with gumma. X-ray (L) leg showed a punched out erosion of left tibia with surrounding periosteal thickening.
Patient was treated with injection crystalline penicillin 4 million units IV every four hours for 14 days followed by benzathine penicillin 2.4 mega units IM weekly X 3 weeks. Inspite of treatment ulcer persisted. Hence a repeat biopsy was done which showed features of well differentiated squamous cell carcinoma.
| Discussion|| |
Gumma is a rarity now-a-days due to early detection of syphilis and proper use of antibiotics. The diagnosis of gumma was missed early in this case due to lack of awareness among nondermatologists. Our patient had clinical, radiological and histiological evidence of gumma. Blood examination for VDRL is mandatory for all patients with chronic non-healing ulcers.
Squamous cell carcinoma arising from gumma is all the more rare. Unresponsiveness to specific treatment should provoke us to look for evidence of malignancy in chronic ulcers.
| References|| |
|1.||Rhodes AR, Lugar AFH. Syphilis and other treponematoses. In: Fitzpatrick TB, Eisen AZ, Wolf K, et al. eds. Dermatology in General Medicine, 3 rd ed. New York: Mc-Graw Hill, 1987; 23: 95-2452. |
|2.||Egistein WH, Kelly EC. Cutaneous gumma-a contemporary disease. South Med J 1969;62:976-977. |
[Figure - 1], [Figure - 2]