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E-CORRESPONDENCE
Year : 2013  |  Volume : 58  |  Issue : 4  |  Page : 329
Multiple squamous cell carcinoma over lichen simplex chronicus: A rare entity


1 Department of Dermatology, Dr. D.Y. Patil Medical College and Hospital, Santtukaram Nagar, Pimpri, Pune, India
2 Department of Surgery, Dr. D.Y. Patil Medical College and Hospital, Santtukaram Nagar, Pimpri, Pune, India

Date of Web Publication25-Jun-2013

Correspondence Address:
Palak Deshmukh
Department of Dermatology, Dr. D.Y. Patil Medical College and Hospital, Santtukaram Nagar, Pimpri, Pune
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.114006

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How to cite this article:
Deshmukh P, Sharma YK, Chaudhari ND, Dogra BB, Deo KS. Multiple squamous cell carcinoma over lichen simplex chronicus: A rare entity. Indian J Dermatol 2013;58:329

How to cite this URL:
Deshmukh P, Sharma YK, Chaudhari ND, Dogra BB, Deo KS. Multiple squamous cell carcinoma over lichen simplex chronicus: A rare entity. Indian J Dermatol [serial online] 2013 [cited 2019 May 20];58:329. Available from: http://www.e-ijd.org/text.asp?2013/58/4/329/114006


Sir,

Squamous cell carcinoma (SCC) is derived from suprabasal epidermal keratinocytes. It comprises 25% of total non-melanoma skin cancers in white population with a male to female ratio of 2:1. There are various predisposing risk factors such as Bowen disease, UV radiation, environmental carcinogens, immunosuppression, HPV, chronic scarring and inflammatory dermatoses, etc. [2] However, there are very few reports of lichen simplex chronicus preceding the development of SCC. Herein, we report one such rare case.

A 37 year old female, presented with discharging ulcerative growth over anteromedial aspect of left leg since six months and raised itchy thickenings over lower thirds of both legs since four months. History of excruciatingly itchy discoloured patches over legs since 25 years. There was no similar illness in the family. Dermatological examination revealed involvement restricted to legs [Figure 1]a, b, c, d. There were two plaques over left leg; one 8 × 7 cm sized, malodorous ulceroproliferative growth with unhealthy granulation tissue, irregular margins and a second diffuse hypopigmented verrucous plaque over the shin. Right shin revealed a 2 × 2 cm solitary depigmented verrucous plaque. Marked excoriations were present in the area surrounding the plaques. On palpation all the plaques were indurated, non-tender, freely mobile fixed neither to the overlying skin nor to the underlying muscle or bone. There was no lymphadenopathy. Complete haemogram, X-ray chest and X-ray of both legs was normal. Wedge biopsy taken from the ulceroproliferative growth and the shin plaques revealed keratin pearls in the dermis [Figure 2]a. The histopathological examination of the surrounding area was consistent with the features of lichen simplex chronicus [Figure 2]b.
Figure 1: (a) Multiple SCC lesions over both limbs, (b) 8 × 7cm fungating mass over antero - medial infrapatellar region, (c) and (d) Verrucous plaques over depigmentedpatchs with surrounding excoriations

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Figure 2: (a) Histopathology showing keratin pearls in the dermis. (H and E, ×400). (b) Histopathological view showing hyperkeratosis and elongation of rete ridges. (H and E, ×40)

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The growths were subjected to wide local excision followed by split thickness skin grafting [Figure 3]. Histopathology of the excised specimens corroboratedthe diagnosis of SCC.
Figure 3: After split thickness skin grafting

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SCC is a malignant tumor arising from the keratinocytes of the epidermis whose cells shows some degree of maturation towards the keratin formation. Only a relatively small number of these tumors arise without any previous exogenous cause. [2] Many of the environmental carcinogens e.g., ultraviolet light (the single major causative agent), chemicals and HPV may be responsible, singly or in combination. [1] SCC is an occasional complication of chronic granulomas as well as chronic dermatoses which include lymphogranulomavenereum, syphilis, lupus vulgaris, leprosy, lupus erythematosus, osteomyelitic sinuses, old burn scars and hidradenitis suppurativa, etc., SCC may complicate scarring dermatoses such as poikilodermacongenitale, dystrophic epidermolysisbullosa, and porokeratosis of Mibelli. [2] Most chronic dermatosessuch as factitial dermatitis, chronic ulcer, lichen sclerosus, lichen planus, prurigonodularis may result into malignancy. [1] Additional aetiological factors implicated in the development of cutaneous SCC in some populations include chronic exposure to thermal radiation. [2]

Chronic cutaneous inflammatory processes, with oncogenic-like "overdrive" of growth factors constantly stimulating epithelial cells, may lead to malignant transformation. We think the continuous and repetitive trauma on inflamed tissues might have significantly contributed to development of the neoplasia in our patient. [1] This type of carcinoma might also be included in the group of SCC arising within chronic cutaneous dermatoses.

To the best of our knowledge, both the earlier reported cases of SCC over lichen simplex chronicus. Hence occurrence of multiple SCCs over underlying lichen simplex chronicus in our present case report appears to be first reported instance of occurrence of multiple SCCs over underlying Lichen Simplex Chronicus.

 
   References Top

1.Wu M, Wang Y, Bu W, Jia G, Fang F, Zhao L. Squamous cell carcinoma arising in lichen simplex chronicus. Eur J Dermatol 2010;20:858-9.  Back to cited text no. 1
    
2.Masood Q, Manzoor S. Squamous cell carcinoma arising from lichen simplex chronicus. Indian J Dermatol 2000;40:90-1.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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