Epithelioma complicating lupus erythematosus

Cutaneous squamous cell carcinoma causing a rhinophymatous mass in a patient with clinically occult hypertrophic lupus erythematosus

Hypertrophic lupus erythematosus is a variant of discoid lupus erythematosus, which manifests as verrucous plaques and/or keratoacanthoma-like nodules on the face and arms. Diagnosis and treatment of hypertrophic lupus erythematosus can be challenging as it can resemble cutaneous squamous cell carcinoma clinically and histopathologically. Furthermore, cutaneous squamous cell carcinoma is a known complication of discoid lupus erythematosus. We present a diagnostically challenging case of a patient with a rapidly enlarging rhinophymatous mass and multiple keratoacanthoma-like lesions of the bilateral upper extremities whose work-up was initially equivocal. CD123 staining helped to elucidate a final diagnosis of cutaneous squamous cell carcinoma arising in a background of occult hypertrophic lupus erythematosus.

Rheumatologic manifestations of malignancy

The relationship between rheumatologic syndromes and cancer covers a very broad array of both common and distinctly rare manifestations. This discussion has outlined some of the known relationships that do exist. A high index of suspicion by both the primary care physician and subspecialist will enhance the probability of detecting cancer in the patient who may present with rheumatologic complaints.

Squamous cell carcinoma complicating late chronic discoid lupus erythematosus

Two cases of squamous cell carcinoma developing in lesions of chronic cutaneous discoid lupus erythematosus are presented. One of the patients was white and the other was black. The squamous cell carcinoma in the black patient proved to be rapidly metastatic and eventually fatal. The white patient developed seven squamous cell carcinomas over 8 years with no evidence of metastatic spread. The role of ultraviolet light in inducing skin cancer in these patients is discussed.

Rheumatologic manifestations of cancer

A variety of musculoskeletal syndromes have been described in association with malignancy. The majority of such descriptions have dealt with the connective tissue disorder as a paraneoplastic syndrome, frequently the presenting feature of an otherwise occult malignancy. This may range from the well known syndrome of HOA, heralding lung cancer, to a lesser known association of pyogenic arthritis due to an unusual enteric pathogen, signaling colon cancer. Conversely, the connective tissue disorder may precede the malignancy, and by virtue of its pathophysiology or its therapy, foster the subsequent development of cancer. Awareness of these associations may lead to earlier cancer detection, and hence, potentially more effective therapy.

Squamous cell carcinoma of the lip developing in discoid lupus erythematosus

Since the substitution of steroids and antimalarials for irradiation in the treatment of discoid lupus erythematosus, squamous cell carcinoma arising in discoid lupus erythematosus is thought by some to be an uncommon occurrence. A review of the recent literature (subsequent to 1945) revealed fifteen cases, of which seven occurred in the lips. In one of twelve of the cases a history of irradiation was documented. In three other cases, there was no evidence of its use. We report an additional case of squamous cell carcinoma occurring in the lower lip of a 24-year-old black woman in the absence of radiation therapy. A review of the literature and a discussion of possible predisposing factors are presented.

Musculoskeletal syndromes associated with malignancy

Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. Early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.