Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2013  |  Volume : 58  |  Issue : 2  |  Page : 151-153
Multicentric squamous cell carcinoma arising on psoriatic plaque


Department of Dermatology and Venereology, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratisthan, 99, Sarat Bose Road, Kolkata 700 026, West Bengal, India

Date of Web Publication5-Mar-2013

Correspondence Address:
Jayanta K Das
Department of Dermatology and Venereology, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratisthan, 99, Sarat Bose Road, Kolkata 700 026, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.108065

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How to cite this article:
Gupta M, Das JK, Gangopadhyay A. Multicentric squamous cell carcinoma arising on psoriatic plaque. Indian J Dermatol 2013;58:151-3

How to cite this URL:
Gupta M, Das JK, Gangopadhyay A. Multicentric squamous cell carcinoma arising on psoriatic plaque. Indian J Dermatol [serial online] 2013 [cited 2019 Jun 24];58:151-3. Available from: http://www.e-ijd.org/text.asp?2013/58/2/151/108065


Sir,

Psoriasis is a chronic skin condition characterized by epidermal hyperproliferation and altered expression of about 1,300 genes. [1] It is consistently associated with many cutaneous and systemic diseases. Patients with psoriasis are at an increased risk of developing cutaneous malignancy, especially non-melanoma skin cancers and lymphoproliferative disorders. The risk is highest for those with severe psoriasis and also for patients treated with PUVA, methotrexate, topical tar, and biologicals. A 62-year-old farmer presented in our OPD with 10 years' history of psoriasis over knees and elbows. For the last 2 years, he developed a cauliflower-like growth on each elbow over the pre-existing lesion of psoriasis. Before coming to us, he had received only homeopathic treatment without any relief. He did not have any physical signs of arsenicosis, and there was no history of arsenicosis in his locality. There was no family history of psoriasis or of malignancy. Physical examination revealed dirty white verrucous growths over both the psoriatic plaques, measuring around 10 cm by 6 cm on right elbow and around 7 cm by 5 cm on left elbow. The lesions were firm to hard in consistency, not fixed to underlying fascia, muscle, or bone, and there was sero-sanguineous oozing on the right side [Figure 1]. The skin surrounding the growths showed well-defined erythematous plaques with silvery scales. Systemic examination revealed nothing relevant, except multiple firm discrete mobile lymph nodes over both axillae.

Routine hematological and biochemical investigations were within normal limits. Histopathology of a biopsy from both the growths revealed features suggestive of well-differentiated squamous cell carcinoma (SCC) [Figure 2] and [Figure 3]. Histopathology of a biopsy from clinically psoriasis-like lesions outside the margins of the growth on left elbow revealed typical features of psoriasis [Figure 4]. Fine needle aspiration cytology from an enlarged axillary lymph node revealed reactive follicular hyperplasia and no malignant cells. We referred the case to surgical department for further management.
Figure 1: Verrucous growths on both the elbows overlying psoriasis plaques

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Figure 2: Histopathology of the growth on right elbow

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Figure 3: Histopathology of the growth on left elbow

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Figure 4: Histopathology of the psoriasis lesion at the periphery of the growth on left elbow

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The exact incidence of SCC in patients with psoriasis is not known. Olsen et al. in their hospital-based study found SCC in 1% of their patients. [2] Recent studies have shown increased expression of proliferation regulators like Keratin 16, WNT 5A, defensin B4, SERPIN B3, STAT-1 in both psoriasis and SCC. [3] It has also been shown that epidermal proteins like serpin, a squamous cell carcinoma antigen, bind IgG from psoriatic serum. [4] In biopsy specimens of psoriasis and cutaneous neoplasia, persistent activation of Src-family tyrosine kinases (SFKs), known regulators of keratinocyte growth and differentiation, has been shown in another study. [5] Thus, study of literature provides evidence of the presence of various factors conducive for the development of SCC of the skin in patients suffering from psoriasis.

We report the present case considering the rarity of reports describing multiple SCC in a patient of psoriasis not treated with therapeutic modalities that predispose to SCC, and emphasize the necessity of histopathological study of longstanding psoriatic plaques.

 
   References Top

1.Zhou X, Krueger JG, Kao MC, Lee E, Du F, Menter A, et al. Novel mechanisms of T-cell and dendritic cell activation revealed by profiling of psoriasis on the 63,100-element oligonucleotide array. Physiol Genomics 2003;13:69-78.  Back to cited text no. 1
[PUBMED]    
2.Jeevankumar B, Thappa DM, Joseph L, Karthikeyan K. Squamous cell carcinoma arising over psoriatic skin lesion. Indian J Dermatol 2004;49:163-4.  Back to cited text no. 2
  Medknow Journal  
3.Haider AS, Peters SB, Kaporis H, Cardinalel, Fei J, Ott J, et al. Genomic Analysis Defines a Cancer-Specific Gene Expression Signature for Human Squamous Cell Carcinoma and Distinguishes Malignant Hyperproliferation from Benign Hyperplasia. J Invest Dermatol 2006;126:869-81.  Back to cited text no. 3
    
4.Takeda A, Higuchi D, Takahashi T, Ogo M, Baciu P, Paul F, et al. Overexpression of Serpin Squamous Cell Carcinoma Antigens in Psoriatic Skin. J Invest Dermatol 2002;118:147-54.  Back to cited text no. 4
    
5.Ayli E, Li W, Brown T, Witkiewicz A, Elenitsas R, Seykora J. Activation of Src-family tyrosine kinases in hyperproliferative epidermal disorders. J Cut Pathol 2007;35:273-7.  Back to cited text no. 5
    


    Figures

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



 

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