SQUAMOUS CELL CARCINOMA OF THE SKIN ARISING FROM A LEPROMATOUS ULCER: A CASE REPORT

Background: Non-melanoma skin cancers (NMSC) are among the most frequently diagnosed malignancies globally. While basal cell carcinoma predominates in fair-skinned populations, squamous cell carcinoma (SCC) is relatively more common among black populations. Chronic ulcers, including rare cases of lepromatous ulcers, may undergo malignant transformation into SCC.

Case presentation: We present a case of a 65-year-old man with a 20-year history of lepromatous leprosy who developed a chronic right groin ulcer. Initially painless, the lesion began to enlarge rapidly over a 10-month period, becoming painful and frequently bleeding, and leading to difficulty with ambulation. Six months prior to presentation, he underwent a below-knee amputation following a traumatic tibial fracture; histopathology of the amputated limb revealed well-differentiated squamous cell carcinoma (SCC) in a background of lepromatous changes. On referral, examination showed a large ulcerated, fungating mass (12 × 10 × 6 cm) on the right thigh, bilateral matted inguinal lymphadenopathy, and auto-amputation of multiple digits. Biopsies of the mass and nodes confirmed well-differentiated SCC. Metastatic work-up was negative. He received six cycles of combination chemotherapy with Paclitaxel and Cisplatin, resulting in significant tumour regression, followed by external beam radiotherapy to the groin (50 Gy in 25 fractions). He remained disease-free for 18 months before being lost to follow-up.

Conclusion: Squamous cell carcinoma arising from a lepromatous ulcer is rare and poses treatment challenges due to late presentation and comorbidities. High clinical suspicion, early biopsy of chronic ulcers, and a multidisciplinary approach are essential to improving outcomes. This case underscores the importance of long-term surveillance in patients with chronic infectious dermatoses.