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CASE REPORT
Year : 2016  |  Volume : 17  |  Issue : 1  |  Page : 18-20

Malignant transformation of lichen planus hypertrophicus into squamous cell carcinoma


Department of Dermatology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

Date of Web Publication4-Jan-2016

Correspondence Address:
Aniket Bhagwat Bhole
Room No. 96, Hostel No. 4, RIMS, Bariatu - 834 009, Ranchi, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.173152

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  Abstract 

Neoplastic transformation of lichen planus (LP) is reported, but it's a rare event. Squamous cell carcinoma (SCC) complicating cutaneous LP has an incidence of 0.4%. Average age at the time of diagnosis of SCC in patients of LP is 58 years with a range of 29–78 years. We report an extremely rare case of 17-year-old female patient who developed SCC from lichen planus hypertrophicus (LPH), a variant of LP. Patient presented with LPH over the anterior aspect of both legs since the age of 7 years which is again a pediatric rarity. SCC developed over an anteromedial aspect of left ankle after 10 years when she came to us. Both the diagnoses were histopathologically confirmed. The patient was treated with complete excision of tumor and defect was closed with rotation flap. This report emphasizes that the long-standing hypertrophic form of LP seems to have a considerable propensity for malignant transformation, even in the juvenile age group. Hence, careful vigilance of a longstanding LPH is necessary to allow early detection of a developing SCC.

Keywords: Carcinoma, hypertrophicus, lichen planus, youngest age


How to cite this article:
Bhole AB, Sudhanan V M, Mishra D K. Malignant transformation of lichen planus hypertrophicus into squamous cell carcinoma. Indian J Paediatr Dermatol 2016;17:18-20

How to cite this URL:
Bhole AB, Sudhanan V M, Mishra D K. Malignant transformation of lichen planus hypertrophicus into squamous cell carcinoma. Indian J Paediatr Dermatol [serial online] 2016 [cited 2020 Nov 28];17:18-20. Available from: https://www.ijpd.in/text.asp?2016/17/1/18/173152


  Introduction Top


Hypertrophic lichen planus (LPH) is a variant of lichen planus (LP) which presents as thickened, hyperkeratotic, erythematous to violaceous, intensely pruritic papules, and plaques.[1],[2] Although it is a benign disorder, malignant changes may happen and <50 such cases have been reported.[3] We present a case of a 17-year-old female patient with hypertrophic LP from age of 7 years, which turned into squamous cell carcinoma (SCC) after 10 years, that is, at the age of 17 years. The youngest patient ever reported with such presentation till now is 34-year-old Caucasian male.[4] Here, we are reporting it occurring at such a young age of 17 years for the first time.


  Case Report Top


A 17-year-old female student presented with multiple, thickened, itchy plaques with the hypopigmented center and hyperpigmented border on the anterior aspect of both legs for last 10 years with recent onset cauliflower like growth.

Lesions started as hyperpigmented itchy papules around left knee and above left ankle at the age of 7 years that developed gradually into thickened plaques over 10 years. Since last 8 months, a small cauliflower-like hard growth had appeared over the upper end of lesion just above the medial side of left ankle which enlarged insidiously, with a history of moderate pain and bleeding on manipulation. There was no history of trauma, application of counterirritant substances, excessive sun exposure, arsenical contact or X-ray exposure at the local site. Patient gave a history of previous treatment on multiple occasions mostly with topical agents with an only partial response. She was otherwise of normal health and a similar disease wasn't known in her family.

General physical examination was within normal limits without any regional lymphadenopathy. The cutaneous examination revealed four lesions of variable sizes, one on anteromedial aspect of left knee, two just above and anterior to left ankle each on medial and lateral side, and one over medial side of the left ankle. The lesions were thickened, hyperkeratotic, verrucous plaques with depigmented center and violaceous edge. Hard, erythematous, exophytic-like growth of size 3 cm × 2 cm and 2 cm × 1 cm were noticed over anteromedial side above left ankle [Figure 1]. The growth was adherent to underlying structures and not movable with the overlying skin. Examination of the oral cavity, genital mucosa, nails, and hairs revealed no abnormality. There was no lesion of LP elsewhere on the body.
Figure 1: Clinical photograph showing exophytic like growth over anteromedial side above left ankle

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The exophytic lesion was completely excised and the defect was closed with rotation flap. Whole excised mass was sent for histopathological examination.

The slides showed:

  • Irregular epidermal hyperplasia with hyperplastic appendages, wedge-shaped hypergranulosis, occasional colloid bodies at dermoepidermal junction, and moderately dense lymphocytic infiltrate in perivascular areas and around appendages. These findings were typical of LPH
  • Proliferation of anastomosing nests, sheets, and strands of atypical keratinocytes originating in the epidermis and infiltrating into the dermis, dyskeratotic cells, parakeratosis are all observed confirming SCC [Figure 2].


A routine hemogram, liver and renal function tests, chest X-ray, and ultrasonographic study of the abdomen revealed no abnormality.
Figure 2: Histopathology showing proliferation of anastomosing nests, sheets, and strands of atypical keratinocytes originating in the epidermis, breaking the basement membrane, infiltrating into the dermis, and dyskeratotic cells, parakeratosis are all observed confirming squamous cell carcinoma (H and E, ×100)

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  Discussion Top


Neoplastic transformation of cutaneous LP, although reported, is rare with an incidence of 0.4%.[1],[3] It has been described, especially in the oral form of the disease where an estimated 0.3–3% of patients may develop SCC.[5] Immune alterations associated with LP, together with other co-factors, for example, a history of arsenical, ionizing or ultraviolet radiation treatment, may play an important role in the development of SCC in these patients. Furthermore, both chronic inflammation and the accelerated cellular turnover in LP provide a fertile environment for cancer development.[3] LP is considered to be rare in children.[6] Average age at the time of diagnosis of SCC in patients of LP is 58 years with a range of 29–78 years [7],[8] while, it is highly interesting to note that in our case, age at diagnosis of LPH was 7 years and that of SCC was just 17 years.


  Conclusion Top


Hypertrophic LP tends to persist and has a propensity for malignant transformation even in young patients. Hence, careful vigilance of a longstanding LPH is necessary to allow early detection of a developing SCC.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol 1991;25:593-619.  Back to cited text no. 1
    
2.
Tompkins JK. Lichen planus; a statistical study of forty-one cases. AMA Arch Derm 1955;71:515-9.  Back to cited text no. 2
[PUBMED]    
3.
Krasowska D, Kozlowicz K, Kowal M, Kurylcio A, Budzynska-Wlodarczyk J, Polkowski W, et al. Twice malignant transformation of hypertrophic lichen planus. Ann Agric Environ Med 2012;19:787-9.  Back to cited text no. 3
    
4.
Ardabili M, Gambichler T, Rotterdam S, Altmeyer P, Hoffmann K, Stücker M. Metastatic cutaneous squamous cell carcinoma arising from a previous area of chronic hypertrophic lichen planus. Dermatol Online J 2003;9:10.  Back to cited text no. 4
    
5.
Castaño E, López-Ríos F, Alvarez-Fernández JG, Rodríguez-Peralto JL, Iglesias L. Verrucous carcinoma in association with hypertrophic lichen planus. Clin Exp Dermatol 1997;22:23-5.  Back to cited text no. 5
    
6.
Solomon LM, Ehrlich D, Zubkov B. Lichen planus and lichen nitidus. In: Harper J, Oranje A, Prose N, editors. Textbook of Pediatric Dermatology. 2nd ed. Oxford, UK: Blackwell Publishing; 2006. p. 801-12.  Back to cited text no. 6
    
7.
Leal-Khouri S, Hruza GJ. Squamous cell carcinoma developing within lichen planus of the penis. Treatment with Mohs micrographic surgery. J Dermatol Surg Oncol 1994;20:272-6.  Back to cited text no. 7
    
8.
Sigurgeirsson B, Lindelöf B. Lichen planus and malignancy. An epidemiologic study of 2071 patients and a review of the literature. Arch Dermatol 1991;127:1684-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]


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