|Year : 1991 | Volume
| Issue : 4 | Page : 196-197
Disseminated discoid lupus erythematosus with squamous cell carcinoma
V Laxmi Nair, Maria Chacko
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
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.
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) .
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. 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 Carcinomatous action of light may result from the formation of sterol derived carcinogenic substances such as cholesterol oxide 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. Malignant transformation in DLE may be due to nonspecific reasons as in cases of other chronic cicatrizing ulcers.
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.
|1||Squamous 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.|
|2||Parrish 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.|
|3||LO WB and Black HS. Formation of cholesterol derived photoproducts in human skin. J Invest Dermatol, 1972;58: 278-283.|
|4||Allen AC. Skin; in: Anderson's Pathology Vol.11. 8th edition: Editor Kissane JM. St.Louis: The CV Mosby Company, 1985; P 1587.|