Dermatology and Venereology, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Orissa, India.
Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India.
BMJ Case Rep. 2024 Jan 29;17(1):e255306. doi: 10.1136/bcr-2023-255306.
Vitiligo skin has a lesser number of photoprotective melanocytes-theoretically, there is a higher risk of development of non-melanoma skin cancers in such patients. But most studies in Caucasian patients have shown decreased incidence of non-melanoma skin cancers in patients with vitiligo. In Indian patients, there is a paucity of literature on such adverse events. We report a case of actinic keratoses, cutaneous horn with dysplasia and squamous cell carcinoma developing exclusively over photo-exposed vitiligo lesions in an Indian woman in her 60s (housewife, Fitzpatrick skin type V and average daily photo-exposure time 2-4 hours) of long-standing vitiligo vulgaris without any history of phototherapy. The photoprotected lesional skin was completely normal with no clinically appreciable enlarged regional lymph nodes. Shave and elliptical excision of the suspicious lesions were done, and histopathology showed various degrees of malignant transformation in various lesions. The patient was started on topical imiquimod for the lesions of actinic keratoses and was referred for staging and wide excision of squamous cell carcinoma lesion. We report this case for its rarity and to emphasise the fact that there is a need for counselling for lifestyle modification in patients with vitiligo as the use of sunscreens is often not practised by Indian patients due to financial constraints and physical measures such as using full sleeves, high-collared dresses and scarves should be encouraged.
白癜风皮肤中具有较少数量的光保护黑素细胞 - 从理论上讲，此类患者发生非黑素瘤皮肤癌的风险更高。但大多数白种人患者的研究表明，白癜风患者中非黑素瘤皮肤癌的发病率降低。在印度患者中，关于此类不良事件的文献很少。我们报告了一位 60 多岁的印度妇女（家庭主妇，Fitzpatrick 皮肤类型 V，平均每天暴露在阳光下 2-4 小时）的病例，她患有长期的寻常型白癜风，没有光疗史，仅在光暴露的白癜风病变上出现光化性角化病、皮肤角化物伴发育不良和鳞状细胞癌。受保护的病变皮肤完全正常，没有临床上明显的区域性淋巴结肿大。对可疑病变进行了刮除和椭圆形切除，组织病理学显示各病变存在不同程度的恶性转化。为该患者的光化性角化病病变开了咪喹莫特进行局部治疗，并转诊进行分期和广泛切除鳞状细胞癌病变。我们报告这个病例是因为它的罕见性，并强调需要对白癜风患者进行生活方式改变的咨询，因为印度患者由于经济限制和使用长袖、高领连衣裙和围巾等身体措施，往往不使用防晒霜。
