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Year : 1991  |  Volume : 57  |  Issue : 4  |  Page : 196-197

Disseminated discoid lupus erythematosus with squamous cell carcinoma

V Laxmi Nair, Maria Chacko 
 

Correspondence Address:
V Laxmi Nair





How to cite this article:
Nair V L, Chacko M. Disseminated discoid lupus erythematosus with squamous cell carcinoma.Indian J Dermatol Venereol Leprol 1991;57:196-197


How to cite this URL:
Nair V L, Chacko M. Disseminated discoid lupus erythematosus with squamous cell carcinoma. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Sep 20 ];57:196-197
Available from: http://www.ijdvl.com/text.asp?1991/57/4/196/3675


Full Text

Malignant transformation in a lesion of Discoid Lupus Erythematosus (DLE) is rare. It is rarer still in a lesion of short duration. Here is a report of squamous cell carcinoma de­veloping in a lesion of 4 years duration.

 Case Reports



A 37-year-old health inspector was seen for an asymptomatic growth on the lower lip of 6 months duration. Four years ago, he was diagnosed to have DLE and was treated by a dermatologist with chloroquine diphosphate tablets 200 mg thrice daily. Within a year, he developed blurring of vision. He then resorted to ayurvedic treatment, for nearly 3 years. The growth on the lower lip was noticed on an erythematous scaly plaque. He has been a heavy smoker since 12 years. On examina­tion, there were bilateral, asymmetrically dis­tributed, papules and plaques 0.5 - 4 cm in size over the face, ears, vertex of the scalp, trunk and extensor forearms. Some of the plaques had adherent scaling, telangiectasia, depigmentation and atrophy. On the lower lip there was a fungating growth 3.5 X 3 cm in size over an erythematous scaly plaque with atrophy and depigmentation. The submental lymph nodes were enlarged, hard and fixed to the underlying tissues. Systemic examination was normal. Except for a raised ESR, pres­ence of rheumatoid factor and antinuclear antibodies, there were no other laboratory abnormalities. Histopathological examination of the growth was reported as moderately differ­entiated squamous cell carcinoma. Skin bi­opsy was consistent with DLE. He was clini­cally staged as T2 N3. M o (UICC, 1982) .

 Comments



Previous reports of squamous cell carci­noma have been in cases of long standing DLE. The shortest duration on record is in a farmer who developed it a year after the on­set of DLE[1]. To the best of our this is the first report of early malignant transformation from India. The early onset of malignancy in this patient may be related to his job as a health inspector necessitating frequent prolonged exposure to sunlight. Heavy smoking was perhaps a contributing factor. It is suggested that the production of skin cancer by ultravio­let light is initiated by repair of DNA but chances for subsequent errors in DNA repli­cation and a resultant greater potential for malignant transformation is present[2] Carcinomatous action of light may result from the formation of sterol derived carcinogenic substances such as cholesterol oxide[3] The evidence however, is inconclusive. Ultraviolet radiation may also influence the immune sys­tem to favour tumour growth by induction of a population of suppressor lymphoid cells which prevent an immune response against the UV transformed tumour cells.[2] Malignant transformation in DLE may be due to non­specific reasons as in cases of other chronic cicatrizing ulcers.[4]

Though early onset of malignancy in le­sions of chronic DLE is very rare it is likely to occur with intense and prolonged exposure to sunlight.

References

1Squamous cell carcinoma in discoid lupus erythematosus - RAK KOLCZYSTOKOMORKOWYW OGNISKU LISZAJA RU MIENIOWATEGO PRZEWLEKLEGO Gwiezdzinski Z and Szyszymar 0 Stud. Doskonal Lek, Bydgoszez PRZEGL DERM 1972 59/1 37-41; In: Excerpta Medica Dermatology and Venereology, 1973; 27: 360, 2247.
2Parrish JA and Pathak MA :Photomedicine, in : Dermatology in General Medicine. Seconded, Editors, Fitzpatrick TB, Elsen AZ,Wolff, Klaus et al : Mc Graw Hill Book Company, New York, 1979; 942-994.
3LO WB and Black HS. Formation of cholesterol derived photoproducts in human skin. J Invest Dermatol, 1972;58: 278-283.
4Allen AC. Skin; in: Anderson's Pathology Vol.11. 8th edition: Editor Kissane JM. St.Louis: The CV Mosby Company, 1985; P 1587.

 

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