Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA.
Department of Dermatology, University of Tennessee, Memphis, Tennessee, USA.
J Cutan Pathol. 2023 Jan;50(1):19-23. doi: 10.1111/cup.14304. Epub 2022 Aug 23.
Discoid lupus erythematosus (DLE) is the most common type of cutaneous lupus and is clinically characterized by alopecia, depigmentation, and scars on sun-exposed skin. Squamous cell carcinoma is a potential long-term complication. The most important risk factor for squamous cell carcinoma development in people with dark skin is chronic scarring and inflammation, such as those seen in long-standing discoid plaques. African Americans who develop squamous cell carcinoma in the setting of chronic scarring and inflammation have a greater risk of metastasis and recurrence compared to sun-induced squamous cell carcinoma seen in whites. Despite this, the pathogenesis of squamous cell carcinoma development in chronic DLE is not fully understood. Herein, we describe a case of an African American patient who developed squamous cell carcinoma on a long-standing discoid plaque. Analysis of the lesion revealed a null type pattern of p53 protein expression and abundant CD123 plasmacytoid dendritic cells, as potential drivers of oncogenesis and inflammation, respectively. Dermatologists should be aware of the increased risk of squamous cell carcinoma development within long-standing discoid plaques for a prompt early diagnosis and active long-term surveillance.
盘状红斑狼疮（DLE）是最常见的皮肤型狼疮，其临床特征为暴露于阳光的皮肤出现脱发、色素脱失和瘢痕。鳞状细胞癌是一种潜在的长期并发症。对于深色皮肤人群，发生鳞状细胞癌的最重要危险因素是慢性瘢痕和炎症，如长期盘状斑块中所见。与白人中由阳光引起的鳞状细胞癌相比，在慢性瘢痕和炎症背景下发生鳞状细胞癌的非裔美国人转移和复发的风险更高。尽管如此，慢性 DLE 中鳞状细胞癌发展的发病机制仍不完全清楚。在此，我们描述了一例非裔美国患者在长期盘状斑块上发生鳞状细胞癌的病例。对病变的分析显示 p53 蛋白表达呈缺失型模式，以及大量 CD123 浆细胞样树突状细胞，分别为潜在的致癌和炎症驱动因素。皮肤科医生应该意识到长期盘状斑块中鳞状细胞癌发展的风险增加，以便及时进行早期诊断和积极的长期监测。
