Indian Journal of Dermatology
CASE REPORT
Year
: 2014  |  Volume : 59  |  Issue : 2  |  Page : 193--194

Squamous cell carcinoma in a patient with vitiligo of photo-covered skin


Asok Gangopadhyay1, Jayanta Kumar Das1, Amit Kumar Agarwal2,  
1 Department of Dermatology, Vivekananda Institute of Medical Sciences, Kolkata, India
2 Department of Dermatology, Anandloke Hospital and Neurosciences Centre, Siliguri, Darjeeling, West Bengal, India

Correspondence Address:
Amit Kumar Agarwal
G2, Block A, Vandana Apartment, New Milanpally, Siliguri, Darjeeling, West Bengal - 734 005
India

Abstract

Ultraviolet radiation is an important risk factor for the development of skin cancers. Melanin is known to protect the skin against harmful effects of ultraviolet radiation. Hence, vitiligo patients are at higher risk of developing such malignancies. But few reports of occurrence of skin cancers in vitiligo lesions suggest that their occurrence in vitiligo is rare. There are reports of development of Squamous cell carcinoma (SCC) in vitiligo lesions, following long-term Psoralen and Ultraviolet-A (PUVA) therapy. But there are no reports of occurrence of SCC in a vitiligo patch located in photo-covered area. We describe a patient with SCC in a vitiligo patch present in photo-covered skin.



How to cite this article:
Gangopadhyay A, Das JK, Agarwal AK. Squamous cell carcinoma in a patient with vitiligo of photo-covered skin.Indian J Dermatol 2014;59:193-194


How to cite this URL:
Gangopadhyay A, Das JK, Agarwal AK. Squamous cell carcinoma in a patient with vitiligo of photo-covered skin. Indian J Dermatol [serial online] 2014 [cited 2019 Dec 16 ];59:193-194
Available from: http://www.e-ijd.org/text.asp?2014/59/2/193/127685


Full Text

 Introduction



Ultraviolet radiation (UVR) is now recognized as the most important risk factor for the development of Squamous cell carcinoma (SCC). [1] Patients with vitiligo often have no protective pigment in the depigmented skin. Moreover, with severe oxidative stress due to accumulation of millimolar epidermal hydrogen peroxide, it would be expected that these patients develop a higher risk for early photo-damage and SCC. [2],[3] But, sporadic case reports of occurrence of SCC in vitiligo lesions [4],[5] suggest that development of SCC in vitiligo is rare. There have been increased reports of development of SCC in vitiligo lesions, following long-term PUVA therapy. [6] But there are no reports of occurrence of SCC in a vitiligo patch located in photo-covered area. We describe a patient with SCC in a vitiligo patch present in photo-covered skin.

 Case Report



A 65-year-old woman with Fitzpatrick type V skin presented with an asymptomatic keratotic papule in the right knee. She had a single focal vitiligo patch in the right knee for 10 years. There was no family history of vitiligo. As the patch was in a covered area, she did not take any specific treatment for it. She had no history of excessive sun exposure, x-irradiation, or chronic arsenic exposure. The keratotic papule was first noticed 6 months before presentation to us. It grew insidiously to attain the current size in 6 months. Physical examination revealed a round keratotic papule of 1.5 cm in diameter [Figure 1], with irregular surface and firm to hard consistency. The papule was non-tender with no sign of ulceration. The lesion was not fixed to the underlying tissue. There was no significant regional lymphadenopathy. Routine blood investigations, X-ray of chest and right knee were normal. A provisional diagnosis of SCC was made with seborrheic keratosis and keratoacanthoma as differential diagnosis. Excisional biopsy with 5 mm margin on all sides was performed. Histopathological examination of the specimen revealed hyperplastic epidermis with well-differentiated horny pearls in the dermis [Figure 2]a and b. The diagnosis of SCC was made and the patient was referred to an oncologist, who suggested no further treatment. Follow-up examination done 6 months after the biopsy revealed that the area had healed uneventfully, with no signs of recurrences or new lesions.{Figure 1}{Figure 2}

 Discussion



Vitiligo is a common acquired disorder characterized by well-circumscribed depigmented macules devoid of melanocytes. Melanin pigment is known to protect the skin against harmful effects of UVR. Absence of melanin along with severe oxidative stress increases the risk of photodamage and development of SCC. [2],[3] However, reports of skin cancer in vitiligo patients are few. One probable explanation of low incidence of actinic damage and SCC in vitiligo is the protective function of up-regulated wild-type p53. [2],[3] It has been postulated that hyperkeratosis in vitiligo may offer as an efficient photoprotection as the normal stratum corneum in pigmented skin. [7] Also, photo-adaptation and the rate of repair of UVB-induced DNA damage in vitiliginous skin is equivalent to that in normal skin. [8] In our patient, SCC developed in a long-standing vitiligo patch present in an area which was protected from sunlight due to the draping of saree, the traditional dress of Indian women. The patient might have chronic exposure to sunlight, but she may deny that fact due to cultural reasons. With this report, we want to emphasize that even though the occurrence of SCC may be rare in vitiligo patches, there may be a subset of patients with vitiligo who are at risk of developing skin cancer. This population may increase in size with increased usage of phototherapy in the management of vitiligo.

 Acknowledgments



List all contributors who do not meet the criteria for authorship, such as a person who provided purely technical help, writing assistance, or a department head who provided only general support. Financial and material support should also be acknowledged.

References

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