Squamous cell carcinoma arising in long‐standing necrobiosis lipoidica

Santos‐Juanes, Jorge; Galache, Cristina; Curto, JR; Carrasco, M. P.; Ribas, Andrés; Rio, K. J. Sanchez Del

doi:10.1111/j.1468-3083.2004.00444.x

Cited by 39 publications

(21 citation statements)

References 7 publications

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“…In this respect, most of our patients showed a lack of compliance or adherence, despite the psychological strain caused by the cosmetically disfiguring ulcerations and the pain. In addition, regular follow-up is necessary because it has been shown that long-standing chronic ulcerating lesions of necrobiosis lipoidica can lead to squamous cell carcinoma owing to malignant transformation as described in several case reports (28)(29)(30). In addition, an adequate pain therapy is necessary, because all patients in our group described their ulcerations as very painful.…”

Section: Treatmentmentioning

confidence: 88%

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Franklin

Stoffels-Weindorf

Hillen

et al. 2013

International Wound Journal

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Necrobiosis lipoidica is a rare granulomatous disorder of the skin. In up to 30% of the affected patients it can lead to ulcerations, which can impair the quality of life and are also very difficult to treat. Its pathogenesis is not fully understood. Only few studies focussing on necrobiosis lipoidica can be found, but none of them focus on ulcerated necrobiosis lipoidica. Therefore, we collected demographic data and comorbidities and assessed treatment options for patients with ulcerated necrobiosis lipoidica. Data of patients who were treated in the wound care centre of the University Hospital of Essen for ulcerated necrobiosis lipoidica over the past 10 years were retrospectively analysed. Hence, data of altogether ten patients (nine women and one man) with ulcerated necrobiosis lipoidica were collected. Of these, 70% of the patients had diabetes mellitus of which 30% had type I diabetes and 40% had type II diabetes; 60% of the patients suffered from arterial hypertension, obesity and hypercholesterolaemia; 40% of the patients suffered from psychiatric disorders such as depression and borderline disorder. Our clinical data demonstrate an association of ulcerated necrobiosis lipoidica and aspects of metabolic syndrome. This leads to a conclusion that ulcerating necrobiosis lipoidica can be seen as part of a generalised inflammatory reaction similar to the inflammatory reaction already known in the pathophysiology of rheumatoid diseases or psoriasis. In patients with clinical atypical painful ulcerations, necrobiosis lipoidica should be considered as a possible differential diagnosis. Therapists should be aware of associated aspects in patients with ulcerated necrobiosis lipoidica who besides diabetes often suffer from other aspects of a metabolic syndrome with increased cardiovascular risk factors. Therefore, these related comorbidities should also be diagnosed and treated.

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Section: Treatmentmentioning

confidence: 88%

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Franklin

Stoffels-Weindorf

Hillen

et al. 2013

International Wound Journal

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“…7.11). [463][464][465][466][467][468] The simultaneous occurrence of necrobiosis lipoidica with granuloma annulare 469,470 and with sarcoidosis has been reported. 424 However, granuloma annulare and sarcoidosis have been reported in the same patient.…”

Section: Histopathologymentioning

confidence: 99%

The granulomatous reaction pattern

Weedon

2010

Weedon's Skin Pathology

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“…Further studies need to be carried out, with determination of skin thickness before and after treatment and comparisons with the changes seen after topical corticosteroid therapy of NL. Many skin diseases associated with chronic inflammation and scarring, including NL, may be associated with a long‐term risk of malignant transformation to squamous cell carcinoma 13 . Treatment of the lesion, even by a potentially carcinogenic therapy such as UVA1, may therefore reduce this risk, although further studies are required to investigate this.…”

Section: Reportmentioning

confidence: 99%

UVA1 phototherapy for treatment of necrobiosis lipoidica

et al. 2006

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The primary cause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr Hönle; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01 UVB (n = 2), topical psoralen plus UVA (PUVA) soaking (n = 2) or oral PUVA (n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.

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Squamous cell carcinoma arising in long‐standing necrobiosis lipoidica

Cited by 39 publications

References 7 publications

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

The granulomatous reaction pattern

UVA1 phototherapy for treatment of necrobiosis lipoidica

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