Research Article

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

Charles Okwonna1*, Mahmud Ahmed2, Sunday A. Adewuyi3, Adamu Abdullahi4, Shehu Salihu Umar5
1 St Lukes Cancer Centre, Royal Surrey County Hospital, Guildford, Surrey
2 Department of Radiation and Clinical Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
3 Department of Radiation and Clinical Oncology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria.
4 Department of Radiology, Ahmadu Bello University Zaria, Kaduna State, Nigeria; Department of Radiation and Clinical Oncology, Ahmadu Bello University, Teaching Hospital, Zaria, Kaduna State, Nigeria
5 Department of Radiology, Ahmadu Bello University Zaria, Kaduna State, Nigeria
* Corresponding author: charles.okwonna@npmcn.edu.ng
Published: Feb, 2026
DOI: 10.67579/njo.2026.mvp44bin
Pages: 124-129
Views: 273
Downloads: 177

Abstract

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.


Keywords

Leprosy squamous cell carcinoma Nigeria skin cancer

References

  1. Gershon A, Gaillard F, Bell D, et al. WHO classification of skin tumours. Radiopaedia.org [Internet]. Reference article; 2025 Jul 13 [cited 2025 Jul 13]. Available from: https://doi.org/10.53347/rID-95692
  2. Fortarezza F, Cazzato G, Ingravallo G, Dei Tos AP. The 2023 WHO updates on skin tumors: advances since the 2018 edition. Pathologica. 2024 Aug;116(4):193–206. doi:10.32074/1591-951X-1006.
  3. Khayyati Kohnehshahri M, Sarkesh A, Mohamed Khosroshahi L, HajiEsmailPoor Z, Aghebati-Maleki A, Yousefi M, et al. Current status of skin cancers with a focus on immunology and immunotherapy. Cancer Cell Int. 2023 Aug 21;23(1). doi:10.1186/s12935-023-03012-7.
  4. Roky AH, Murshedul-Islam M, Ahasan AF, Mostaq MS, Mahmud MZ, Nurul-Amin M, Mahmud MA. Overview of skin cancer types and prevalence rates across continents. Cancer Pathog Ther. 2025;3(2):89–100.
  5. Erb P, Ji J, Kump E, Mielgo A, Wernli M. Apoptosis and pathogenesis of melanoma and nonmelanoma skin cancer. Adv Exp Med Biol. 2008;283–295. doi:10.1007/978-0-387-77574-6_22.
  6. Okwor VC, Folasire A, Okwor CJ, Nwankwo K, Ntekim A, Arua CS. Clinico-epidemiological profile of skin cancer in South Western Nigeria. Malawi Med J. 2024 Jul;36(2):67–72. doi:10.4314/mmj.v36i2.2.
  7. Madubuike KC, Ndukwe CO, Chiemeka ME, Ozor NS, Ogbu CC, Ezejiofor IF. Histopathological pattern and audit of skin tumors seen in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria: a 10-year retrospective study. J Appl Sci Clin Pract. 2024 Jan;5(1):40–47. doi:10.4103/jascp.jascp_41_23.
  8. Dos Santos AGE, Moreira AA. Malignant transformation of a long-term ulcer in a patient with leprosy sequelae: a case report. J Vasc Bras. 2024 Sep 3;23:e20240044. doi:10.1590/1677-5449.202400442.
  9. Schoeman BJ. Squamous cell carcinoma in neuropathic plantar ulcers in leprosy: another example of Marjolin's ulcer. S Afr Med J. 1996 Aug;86(8):966–969.
  10. World Health Organization. Leprosy [Internet]. Geneva: WHO; 2025 [cited 2025 May 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/leprosy
  11. Fahradyan A, Howell A, Wolfswinkel E, Tsuha M, Sheth P, Wong A. Updates on the management of non-melanoma skin cancer (NMSC). Healthcare. 2017 Nov 1;5(4):82. doi:10.3390/healthcare5040082.
  12. Stewart CM, Garlick J, McMullin J, Siddiqi F, Crombie C, Rockwell WB, et al. Surgical excision of non-melanoma skin cancer in an elderly veterans affairs population. Plast Reconstr Surg Glob Open. 2014 Dec;2(12). doi:10.1097/GOX.0000000000000234.
  13. Moore BA, Weber RS, Prieto V, El-Naggar A, Holsinger FC, Zhou X, et al. Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. Laryngoscope. 2005 Sep;115(9):1561–1567.
  14. Moloney M. Enhancing cosmesis while achieving high cure-rates for early-stage non-melanoma skin cancer in the outpatient dermatology clinic using novel non-invasive modality. Am J Biomed Sci Res. 2021 May 7;12(6):525–532. doi:10.34297/ajbsr.2021.12.001803.
  15. Yosefof E, Kurman N, Yaniv D. The role of radiation therapy in the treatment of non-melanoma skin cancer. Cancers (Basel). 2023 Apr 22;15(9):2408. doi:10.3390/cancers15092408.
  16. Gonzalez-Cardenas E, et al. Lymph node metastases from non-melanoma skin cancer of the head and neck: a review. Cancers (Basel). 2023;15(17):4201. doi:10.3390/cancers15174201.
  17. Canadian Cancer Society. Radiation therapy for non-melanoma skin cancer [Internet]. Canada: Canadian Cancer Society; [cited 2025 May 29]. Available from: https://cancer.ca/en/cancer-information/cancer-type/skin-non-melanoma/treatment/radiation-therapy
  18. Chren MM, Torres JS, Stuart SE, Berthental D, Labrador RJ, Boscardin WJ. Recurrence after treatment of nonmelanoma skin cancer. Arch Dermatol. 2011 May;147(5):540–546.
How to Cite

Okwonna, C., Ahmed, M., Adewuyi, S. A., Abdullahi, A., & Umar, S. S. (2026). SQUAMOUS CELL CARCINOMA OF THE SKIN ARISING FROM A LEPROMATOUS ULCER: A CASE REPORT. Nigerian Journal of Oncology, 2(1), 124-129. https://doi.org/10.67579/njo.2026.mvp44bin

C. Okwonna, M. Ahmed, S. A. Adewuyi, A. Abdullahi, and S. S. Umar, "SQUAMOUS CELL CARCINOMA OF THE SKIN ARISING FROM A LEPROMATOUS ULCER: A CASE REPORT," Nigerian Journal of Oncology, vol. 2, no. 1, pp. 124-129, February 2026. doi: 10.67579/njo.2026.mvp44bin

Share this article:
Facebook X / Twitter LinkedIn
Download PDF View Full Text (PDF) Back to Articles