A precancerous saree lesion: a rare occurrence

Abstract

<p class="abstract"><span lang="EN-US">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.</span></p>

Dhoti cancer – A name forgotten!!!

“…Wide local excision (with a surgical margin of at least 2 cm) together with skin grafting is considered as the appropriate treatment. 3 SCCs which develop on chronic skin lesions have a higher incidence of metastasis (9% to 36%) as compared to the carcinomas which arise in previously normal skin (1% to 10%). 13 Other non-surgical options include topical application of 5 fluorouracil and imatinib in low risk group.…”

“…Clothing performs a range of social and cultural function such as individual, occupational and sexual diffrentiation and social status. 3 In India, the traditional ethnic wear in most parts is a dhoti and saree. The dhoti is worn by men tightly around the waist with one of the shorter ends carried under the groin and tucked at the back.…”

“…It is draped around waist over inner skirt (petticoat) which is tightened by a thick cord. 3,4 The tight knot at a constant position for long hours around the waist causes skin friction. The persistent irritation of the tight petticoat cord and saree is compounded by the hot and humid tropical climate of the subcontinent and reluctant self hygiene, especially in Indian rural hinterland.…”

“…It has been suggested that cellular mutations are responsible for the neoplastic changes that occur in the body cells. 3 Castillo and Goldsmith 9 proposed that a depressed immunologic state which is produced by the surrounding scar tissue can predispose to malignant degeneration. The absence of lymphatic drainage from the scar allows a significant delay in the host immunologic recognition, and the antitumour immunologic response is poor.…”

“…Radiation may be an option in high risk group when surgery causes compromised cosmesis. 3 Administration of chemotherapy before surgical management decreases tumor load. Addition of chemotherapy for radio sensitization of the tumor improves outcome in patients with advanced disease.…”