Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 73, Num. 1, 2007, pp. 54-55

Indian Journal of Dermatology, Venereology and Leprology, Vol. 73, No. 1, January-February, 2007, pp. 54-55

Letter To Editor

Squamous cell carcinoma in hypertrophic lichen planus

Joshi Rajiv, Durve Utpal

Consultant Dermatologist and Dermatopathologist, P. D. Hinduja Hospital, Mumbai
Correspondence Address:14 Jay Mahal, A Road, Churchgate, Mumbai - 400 020, rsjdr@rediffmail.com

Code Number: dv07018

Sir,

We read with interest the article "Malignant transformation of hypertrophic lichen planus" by Sengupta et al .[1] We had encountered a similar case of malignant transformation occurring in hypertrophic lichen planus.

Neoplastic transformation (development of squamous cell carcinoma / verrucous carcinoma) in lichen planus has been described, especially in the oral form of the disease where an estimated 0.3-3% of patients may develop squamous cell carcinoma.[2] Malignancy though uncommon with cutaneous lichen planus has been described in chronic hypertrophic lesions of lichen planus on the legs,[3],[4],[5] including a case of metastatic squamous cell carcinoma developing in a 34-year-old male in chronic hypertrophic lesions of lichen planus on the legs of more than 10 years duration.[6]

We describe a 25-year-old male who presented to one of us (UD) with a non-healing ulcer over the anterior aspect of the left leg just above the ankle of about four to five months duration [Figure - 1]. The ulcer was large, 4 cm in diameter and with a raised everted keratotic edge. The ulcer floor was hypertrophic, covered with slough and keratotic crusts; the lesion was friable and bled on manipulation. The surrounding skin was thickened, lichenified and pigmented. Both legs had postinflammatory changes at sites of earlier lesions. No significant inguinal lymphadenopathy was present.

He gave a history of multiple raised rough pruritic lesions on both the legs for several years and had been taking treatment off and on from several dermatologists for at least four years prior to this presentation. The earlier clinical diagnoses were chronic lichenified eczema and hypertrophic lichen planus; however, no biopsy had been done in the past. Previous treatments included topical betamethasone and salicylic acid with partial response.

A biopsy from the ulcer margin showed features of hypertrophic lichen planus towards one end of the section with hyperplastic follicular infundibula that showed interface changes and a lichenoid lympho-histiocytic infiltrate with melanophages at their bases [Figure - 2],[Figure - 3]. The other end of the section showed irregular hyperplasia of the epidermis with atypia of the lower epithelium and in the dermis showed an invasive squamous cell carcinoma with irregular jagged tongues of atypical epithelium infiltrating the dermal tissue. A second biopsy from the ulcer floor showed a keratotic squamous cell carcinoma with horn pearl formation.

Development of squamous cell carcinoma in lesions of hypertrophic lichen planus has been described in Indians,[7],[8] as has been a case of squamous cell carcinoma developing in a plaque of lichen simplex chronicus.[9]

Hypertrophic lichen planus on the legs tends to persist and has a propensity for malignant transformation even in young patients. Therefore nonhealing ulcers overlying such lesions should be viewed with great suspicion and biopsy performed to rule out squamous cell carcinoma.

References

Copyright 2007 - Indian Journal of Dermatology, Venereology and Leprology

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