Squamous Cell Carcinoma in a Patient with Vitiligo of Photo-covered Skin
A 65-year-old woman with Fitzpatrick type V skin presented with an asymptomatic keratotic papule in the right knee. She had a single focal vitiligo patch in the right knee for 10 years. There was no family history of vitiligo. As the patch was in a covered area, she did not take any specific treatment for it. She had no history of excessive sun exposure, x-irradiation, or chronic arsenic exposure. The keratotic papule was first noticed 6 months before presentation to us. It grew insidiously to attain the current size in 6 months. Physical examination revealed a round keratotic papule of 1.5 cm in diameter [], with irregular surface and firm to hard consistency. The papule was non-tender with no sign of ulceration. The lesion was not fixed to the underlying tissue. There was no significant regional lymphadenopathy. Routine blood investigations, X-ray of chest and right knee were normal. A provisional diagnosis of SCC was made with seborrheic keratosis and keratoacanthoma as differential diagnosis. Excisional biopsy with 5 mm margin on all sides was performed. Histopathological examination of the specimen revealed hyperplastic epidermis with well-differentiated horny pearls in the dermis [Figure and ]. The diagnosis of SCC was made and the patient was referred to an oncologist, who suggested no further treatment. Follow-up examination done 6 months after the biopsy revealed that the area had healed uneventfully, with no signs of recurrences or new lesions.