Synchronous non-collision melanoma and basal cell carcinoma arising from chronic lymphedema: a case report and review of literature

Abstract

Chronic lymphedema (CL) due to failure of lymphatic drainage harbors an immunologically vulnerable environment for the development of various neoplasms. Independently, either melanoma or basal cell carcinoma (BCC) arising from CL has only been reported, but synchronous melanoma and BCC originating from CL is never reported. We report a very rare case of synchronous melanoma and BCC arising from the lymphedematous upper extremity developed secondary to axillary lymphadenectomy for breast cancer. Additionally, a literature review reporting either melanoma or BCC in the lymphedematous area was performed using Medline and PubMed databases.

Giant Ulcerative Basal Cell Carcinoma with Local Metastasis: A Case Report and Assessment of Surgical Techniques

“…Recurrences at the primary site or other locations are considered one of the main challenges in GBCC management. A patient with BCC has a 45.2% risk of developing another BCC within 5 years [13]; therefore, lifelong or prolonged follow-up with regular skin screening is recommended [14].…”

A case of multiple basal cell carcinomas in an immunocompromised skin district: The aetiopathogenetic role of congenital lymphqedema

“…1,2 Numerous cutaneous malignancies have been described in lymphoedematous areas in literature, such as basal cell carcinoma, squamous cell carcinoma, melanoma, Kaposi sarcoma, Merkel cell carcinoma and several cutaneous lymphomas. [4][5][6] There are two main hypotheses about the promotion of skin cancer by lymphoedema. 4,5 The first one is the impaired lymphatic circulation causing chronic inflammation and altering Langerhans cells (LC) function and migration.…”

“…[4][5][6] There are two main hypotheses about the promotion of skin cancer by lymphoedema. 4,5 The first one is the impaired lymphatic circulation causing chronic inflammation and altering Langerhans cells (LC) function and migration. These alterations cause a decrease in LC expression of MHC class II molecules, thus antigen presentation in association with these molecules is impaired.…”

“…These alterations cause a decrease in LC expression of MHC class II molecules, thus antigen presentation in association with these molecules is impaired. 5,7 Furthermore, chronic lymphoedema has been shown to cause proangiogenic factors increase, in particular vascular endothelial growth factor (VEGF), which promotes skin carcinogenesis by altering cell growth and proliferation. 4,5 In literature, cases of basal cell carcinomas in immunocompromised districts caused by secondary lymphoedema have already been described 5,8,9 ; however, this would be the first reported case of three basal cell carcinomas arising from an ICD after a primary lymphoedema simultaneously.…”