A precancerous saree lesion: a rare occurrence
Keywords:Saree cancer, Marjolin’s ulcer, Squamous cell carcinoma, Cutaneous
Skin cancers are relatively uncommon malignancies; their incidence in India being less than 1% of all cancers. The incidence of malignancy in scar tissues is 0.1-2.5%. Squamous cell carcinoma of skin is second most common amelanotic malignancy next to basal cell carcinoma. The occurrence of this disease is noticed in various parts of the body but waist line skin is not a common site. Saree is a type of female costume and dhoti is a male costume which is unique to the Indian subcontinent. The persistent and long term wearing of this costume results in depigmentation and glazing of the skin, acanthosis, dysplasia, scar and ulceration and subsequent, but very slow, malignant changes. The exact mechanism of the malignant transformation is unknown, but recurrent trauma over a long period with consequent interference with the healing process is a possible explanation. We are presenting a rare case of left flank ulcero-proliferative growth in a 75 year old woman. Wide excision with primary skin closure was done. Histopathology showed pseudoepitheliomatous hyperplasia with marked dysplasia without microinvasion. It is a premalignant lesion. The case needs its reporting due to its rarity. Awareness of saree cancer among Indians is important to prevent malignant lesions at waistline. Multimodality management with surgery, chemotherapy and radiotherapy is ideal for good outcome.
Khanolkar VR, Suryabai B. Cancer in relation to usages: three new types in India. Arch Pathol. 1945;40:351.
Eapen BR, Shabana S, Anandan S. Waist dermatoses in Indian women who wear sarees. Indian J Dermatol Venereol Leprol. 2003;69:88-9.
Patil AS, Bakhshi GD, Puri YS, Gedham MC, Naik AV, Joshi RK. Saree cancer. Bombay Hosp J. 2005;47(3):302-3.
Trent JT, Kirsner RS. Wounds and malignancy. Adv Skin Wound Care. 2003;16(1):31-4.
Neve EF. Squamous cell epithelioma due to Kangri burns. Indian Med Gazette. 1924;59:341-4.
Darjani A, Mohtasham-Amiri Z, Amini KM, Golchai J, Sadre-Eshkevari S, Alizade N. Skin Disorders among Elder Patients in a Referral Center in Northern Iran (2011). Dermatol Res Pract. 2013;2013:193205.
Glover DM, Kiehn CL. Marjolin’s ulcer: preventable threat to function and life. Am J Surg. 1949;78:772-80.
Neuman Z, Ben-Hur N, Shulman J. Trauma and skin cancer: implantation of the epidermal elements and the possible cause. Plast Reconstr Surg. 1963;32:649-56.
Copcu E, Aktas A, Sismant N, Oztan Y. Thirty-one cases of Marjolin’s ulcer. Clin Exper Dermatol. 2003;28:138-41.
Castillo J, Goldsmith HS. Burn scar carcinoma. Cancer J Clin. 1968;18:140-2.
Fishman JRA, Parker MG. Malignancy and chronic wounds: Marjolin’s ulcer. J Burn Care Rehabil. 1991;12:218-23.
Harland DL, Robinson WA, Franklin WA. Deletion of the p53 gene in a patient with aggressive burn scar carcinoma. J Trauma. 1997;42:104-7.
Lee SH, Shin MS, Kim HS. Somatic mutations of the Fas (Apo-1/ CD95) gene in cutaneous cell carcinomas which arose from burn scars. J Invest Dermatol. 2000;114(1):122-6.
Brantsch KD, Meisner C, Schönfisch B, Trilling B, Wehner-Caroli J, Röcken M, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008;9(8):713-20.
Gupta RL. Disease of skin. In: Gupta RL, eds. Textbook of Surgery. 2nd ed. New Delhi: Jaypee; 2003: 345.
Cruickshank AH, McConnell EM, Miller DG. Malignancy in scars, chronic ulcers and sinuses. J Clin Pathol. 1963;16:573-80.
National Comprehensive Cancer Network. Basal cell and Squamous cell skin cancer, 2013. Available at: http://www.nccn.org/ professionals/physician_gls/pdf/nmsc.pdf.
Motley RJ, Preston PW, Lawrence CM. Multi-professional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Dermatol. 2002;146:18-25.