Case Letter
Squamous cell carcinoma superimposed on necrobiosis lipoidica: a rare complication
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(A), conically shaped operculum; (B), short and thick sleeve fixing to hair shaft; (C), nit without operculum.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gaetano Scanni" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Gaetano" "apellidos" => "Scanni" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220303039" "doi" => "10.1016/j.abdp.2020.09.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220303039?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302257?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000006/v2_202011230629/S0365059620302257/v2_202011230629/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => 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Santos, Renan Rangel Bonamigo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Maria Emilia Vieira de" "apellidos" => "Souza" "email" => array:1 [ 0 => "maria.vsouza@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Julia Kanaan" "apellidos" => "Recuero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Manoella Freitas" "apellidos" => "Santos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Renan Rangel" "apellidos" => "Bonamigo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1202 "Ancho" => 905 "Tamanyo" => 75112 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Small hyperkeratotic ulcerated plaque on a necrobiosis lipoidica lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Necrobiosis lipoidica (NL) is a chronic idiopathic disease, of a granulomatous nature, which affects the dermis. The lesions are characterized by brownish-yellow plaques, and the most common location is the pre-tibial region. It more often affects females (3:1) and appears, in general, from the third decade of life onwards. There is an association with diabetes mellitus (DM), and microangiopathy is considered an etiopathogenic factor for the condition. Ulceration is a common complication, while reports of the onset of squamous cell carcinoma (SCC) in NL lesions are rare.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> After reviewing the literature, 16 cases of SCC in NL lesions were retrieved.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 62-year-old female patient presented an ulcerated, hyperkeratotic lesion in the NL area, on the right leg, about three months prior, with no history of local trauma. She had been diagnosed with NL in the pre-tibial region of both legs ten years before, with no history of recurrent ulceration. The patient had controlled systemic arterial hypertension and type 2 DM. She used oral hypoglycemic agents, with good control in the last years, and did not present retinopathy or diabetic nephropathy. At the physical examination, the patient presented atrophic bilateral plaques on the pre-tibial region and, on her right leg, a small hyperkeratotic ulcerated plaque over a NL lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The anatomopathological examination showed a moderately differentiated SCC with invasion of the reticular dermis in an NL lesion (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). No palpable lymphadenomegalies were observed. The SCC was excised and the wound was closed with a graft. The patient evolved well in the immediate and late postoperative period. The anatomopathological examination showed tumor-free margins.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">NL is a chronic degenerative disease of the dermal connective tissue characterized clinically by yellowish plaques with a narrow granulomatous border, central atrophy, and a tendency to ulceration, most commonly affecting the pre-tibial region of the lower limbs. It is more frequently observed in diabetic patients and, unlike in the reported, most patients also present microvascular complications related to DM, such as nephropathy and retinopathy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of NL are uncertain; it is believed that external trauma, primary vascular disorders, and microangiopathy can contribute to its development, regardless of the presence of DM.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The onset of SCC in areas of ulceration and scarring is well documented in a variety of skin diseases. Ulceration is the main complication of NL, observed in a quarter of patients with this disease. However, despite presenting a chronic course and a tendency to ulceration, the onset of SCC in NL lesions has been seldom reported. It is not clear whether the transformation to SCC is the result of chronic ulceration or of long-standing changes in NL. Risk factors that may be involved in malignant transformation include loss of melanin, which facilitates the lesion, chronic inflammation, and hypoxia.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> In the present patient, the neoplasm presented as a new ulceration ten years after the diagnosis of the disease, a long period – similarly to other cases described in the literature. However, unlike others, the present case of SCC on an NL lesion did not have a history of recurrent or intractable ulcers.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Metastases have been described in the literature, and may be related to delayed diagnosis (ulcerations are common in NL, delaying the diagnosis of SCC).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the case reported, diagnosis and treatment were performed early; the patient is currently being followed-up and is without lymph node metastases or the appearance of new lesions. To the best of the authors’ knowledge, this is the 17<span class="elsevierStyleSup">th</span> case reported in the international literature.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The onset of SCC on a NL lesion is very rare. This possibility should be considered in patients with NL with chronic ulcers, as well as in new lesions in patients with NL. Early detection and treatment of SCC associated with NL is of fundamental importance to allow conservative surgical treatment and the best possible clinical outcome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Maria Emília Vieira de Souza: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Julia Kanaan Recuero: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Manoella Freitas Santos: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo: Approval of the final version of the manuscript, conception and planning of the study, elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-24" "fechaAceptado" => "2020-03-05" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Souza MEV, Recuero JK, Santos MF, Bonamigo RR. Squamous cell carcinoma superimposed on necrobiosis lipoidica: a rare complication. An Bras Dermatol. 2020;95.</p>" ] 1 => array:2 [ "etiqueta" => "⋆⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1202 "Ancho" => 905 "Tamanyo" => 75112 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Small hyperkeratotic ulcerated plaque on a necrobiosis lipoidica lesion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 678 "Ancho" => 905 "Tamanyo" => 185127 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anatomopathological examination indicating a moderately differentiated squamous cell carcinoma with invasion of the reticular dermis (Hematoxylin & eosin, ×20).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 147048 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diffuse areas of collagen degeneration, characteristic of necrobiosis lipoidica (Hematoxylin & eosin, ×5).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrobiosis lipoidica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 8 | 29 |
| 2024 October | 94 | 61 | 155 |
| 2024 September | 146 | 88 | 234 |
| 2024 August | 125 | 102 | 227 |
| 2024 July | 127 | 104 | 231 |
| 2024 June | 104 | 74 | 178 |
| 2024 May | 92 | 61 | 153 |
| 2024 April | 89 | 101 | 190 |
| 2024 March | 81 | 62 | 143 |
| 2024 February | 102 | 77 | 179 |
| 2024 January | 66 | 41 | 107 |
| 2023 December | 72 | 54 | 126 |
| 2023 November | 81 | 76 | 157 |
| 2023 October | 67 | 80 | 147 |
| 2023 September | 74 | 77 | 151 |
| 2023 August | 54 | 24 | 78 |
| 2023 July | 49 | 31 | 80 |
| 2023 June | 67 | 43 | 110 |
| 2023 May | 48 | 20 | 68 |
| 2023 April | 49 | 24 | 73 |
| 2023 March | 48 | 47 | 95 |
| 2023 February | 31 | 32 | 63 |
| 2023 January | 47 | 27 | 74 |
| 2022 December | 54 | 17 | 71 |
| 2022 November | 60 | 61 | 121 |
| 2022 October | 85 | 60 | 145 |
| 2022 September | 39 | 68 | 107 |
| 2022 August | 45 | 59 | 104 |
| 2022 July | 38 | 49 | 87 |
| 2022 June | 46 | 58 | 104 |
| 2022 May | 39 | 53 | 92 |
| 2022 April | 46 | 57 | 103 |
| 2022 March | 39 | 60 | 99 |
| 2022 February | 32 | 46 | 78 |
| 2022 January | 58 | 68 | 126 |
| 2021 December | 34 | 59 | 93 |
| 2021 November | 43 | 58 | 101 |
| 2021 October | 55 | 98 | 153 |
| 2021 September | 29 | 47 | 76 |
| 2021 August | 37 | 59 | 96 |
| 2021 July | 37 | 48 | 85 |
| 2021 June | 35 | 48 | 83 |
| 2021 May | 49 | 64 | 113 |
| 2021 April | 149 | 182 | 331 |
| 2021 March | 132 | 74 | 206 |
| 2021 February | 42 | 21 | 63 |
| 2021 January | 54 | 22 | 76 |
| 2020 December | 31 | 21 | 52 |
| 2020 November | 15 | 8 | 23 |
| 2020 October | 10 | 5 | 15 |
| 2020 September | 11 | 11 | 22 |
| 2020 August | 3 | 4 | 7 |
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