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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 121-123

Saree cancer: A diagnosis!


Department of General Surgery, Padamashree Dr. Dnyandeo Yashwantrao Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India

Date of Web Publication13-Apr-2015

Correspondence Address:
Dr. Mohit Bhatia
Department of General Surgery, Padamashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune - 411018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.154962

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  Abstract 

Saree cancer is a type of skin cancer that occurs along the waistline of Indian women wearing the traditional costume of 'saree'. The incidence of malignancy in scar tissues is 0.1-2.5%. Highly hypopigmented and thickened scars are more likely to progress into malignant lesions. Khanolkar and Suryabai described a new type of skin cancer - 'dhoti cancer' in 1945. Persistent and long term use results in chronic friction/irritation in the region of waist which in term leads to waist-dermatosis.

Keywords: Dermatosis, saree cancer, wide local excision


How to cite this article:
Nirhale DS, Bhatia M, Athavale VS, Calcuttawala M. Saree cancer: A diagnosis!. Arch Med Health Sci 2015;3:121-3

How to cite this URL:
Nirhale DS, Bhatia M, Athavale VS, Calcuttawala M. Saree cancer: A diagnosis!. Arch Med Health Sci [serial online] 2015 [cited 2019 Dec 9];3:121-3. Available from: http://www.amhsjournal.org/text.asp?2015/3/1/121/154962


  Introduction Top


Saree cancer is a type of skin cancer that occurs along the waistline in Indian women wearing saree. It is caused by constant irritation which can result in scaling and changes in pigmentation of the skin. It is a rare type of cancer and generally found in the Indian subcontinent, where the saree is a traditional costume worn by Indian women. It is similar to Marjolin's ulcer in etiology, involving chronic inflammation. The incidence of malignancy in scar tissues is 0.1-2.5%. [1] Highly hypo pigmented and thickened scars are more likely to progress into malignant lesions. Skin cancers are relatively uncommon malignancies which have been seen worldwide. Their incidence in India is less than 1% off all the cancers. Saree is a type traditional costume which is unique to the women of the Indian subcontinent. The exact mechanism of malignant transformation is unknown, but recurrent trauma over a long period with consequent interference with the healing process is a possible explanation. [2]


  Case Report Top


A 55-year-old female patient presented with an ulcer over right lumbar region since 2 years [Figure 1], associated with mild pain at the ulcer site. Pain increased on minimal friction/touch/pressure application it was also asssociated with foul smelling discharge. Local examination showed a solitary, 8 × 10 cm ulceration seen on right lumbar region. Ulcer along the skin creases with irregular margins with everted edges, with slough. Surrounding skin was hyper pigmented and scaly [Figure 1] and [Figure 2]. Tissue biopsy revealed well-differentiated squamous cell carcinoma. Wide local excision was done by clearing the ulcerative lesion completely from its base [Figure 3] [Figure 4] [Figure 5]. Histopathology confirmed the diagnosis of squamous cell carcinoma [Figure 6] and patient was subjected to radiotherapy and patient responded well [Figure 7].
Figure 1: Ulcerative lesion on right lumbar region

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Figure 2: Image showing ulcerative lesion with induration around it

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Figure 3: Biopsy suggestive of squamous cell carcinoma

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Figure 4: Ulcerative lesion being lifted from its base

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Figure 5: Ulcerative lesion completely cleared from its base

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Figure 6: Histopathological slide showing keratin pearls and confi rming diagnosis of squamous cell carcinoma

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Figure 7: Healthy scar after suture removal

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  Discussion Top


Saree cancer is a type of skin cancer that occurs along the waistline in Indian women wearing saree. It is caused by constant irritation which can result in scaling and changes in pigmentation of the skin. It is a rare type of cancer and generally found in the Indian subcontinent, where the saree is a lifetime female costume. It is similar to Marjolin's ulcer in etiology, involving chronic inflammation. The incidence of malignancy in scar tissues is 0.1-2.5%. Highly hypopigmented and thickened scars are more likely to progress into malignant lesions. Khanolkar and Suryabai described a new type of skin cancer - 'dhoti cancer' in 1945. [3] Patil et al., reported a similar type of skin cancer in females which is known as 'saree cancer'. [2] Persistent and long term use results in chronic friction/irritation in the region of waist which in term leads to waist-dermatosis.

Dermatoses like allergic and non-allergic contact dermatitis and dermatophytoses are more commonly seen in body folds and in areas where there is sweating and perspiration. [4] Waist dermatosis due to saree can rarely present as malignancy. A study conducted in India could not find any association with factors, which are commonly accompanied by flexural dermatosis like diabetes, obesity and atopy. Dermatosis giving rise to malignancy is rare. [5]

The precise mechanism by which chronic ulcers (wounds) develop a malignancy is not known and many theories have been postulated. It has been pointed out that every cutaneous scar which is subjected to continuous irritation has an increased potential for malignant degeneration. [6] Neuman et al. [7] proposed that the traumatic displacement of a living epithelial tissue into the dermis may cause a foreign body response and lead to a deranged regenerative process, resulting in a carcinomatous change.

Saree being traditional costume worn by all Indian women, whether it is an ideal outfit for our climate is debatable. [8] The precise mechanism by which chronic ulcers (wounds) develop a malignancy is not known and many theories have been postulated. It has been pointed out that every cutaneous scar which is subjected to continuous irritation has an increased potential for malignant degeneration.


  Conclusion Top


The formation of a non-healing ulcer should alert the physician and the patient. A prompt histopathological evaluation and an early excision of the malignant lesion should be done to prevent disastrous consequences. The exact mechanism of the malignant transformation is difficult to ascertain. Use of broad belt instead of narrow thick cord which will reduce the pressure over waistline which in turn will minimize the changes of malignancy. Regular inspection of the affected part is required to prevent it from transforming into a squamous cell carcinoma.

 
  References Top

1.
Mathai K. (30 January 2012). Sari cancer poses threat to women: Doctors. Times of India. Available form: http://article.wn.com/view/2012/01/29/Sari_cancer_poses_threat_to_women_Doctors/ [Last accessed on 2012 Nov 12].  Back to cited text no. 1
    
2.
Patil AS, Bakhshi GD, Puri YS, Gedham MC, Naik AV, Joshi RK. Saree cancer. Bombay Hosp J 2005;47:302-3.  Back to cited text no. 2
    
3.
Khanolkar VR, Suryabai B. Cancer in relation to usages; three new types in India. Arch Pathol (Chic) 1945;40:351-61.  Back to cited text no. 3
    
4.
Hanifn JM, Rajka RG. Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980;92:44-7.  Back to cited text no. 4
    
5.
Eapen BR, Shabana S, Anandan S. Waist dermatoses in Indian women wearing saree. Indian J Dermatol Venereol Leprol 2003;69:88-9.  Back to cited text no. 5
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6.
Glover DM, Kiehn CL. Marjolin′s ulcer; a preventable threat to function and life. Am J Surg 1949;78:772-80.  Back to cited text no. 6
    
7.
Neuman Z, Ben-Hur N, Shulman J. Trauma and skin cancer: Implantation of epidermal elements and possible cause. Plast Reconstr Surg 1963;32:649-56.  Back to cited text no. 7
    
8.
Bakshi GD, Borisa A, Tayde MB. Waist cancer: Report of two cases. J Indian Med Assoc 2011;109:829, 831.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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Abstract
Introduction
Case Report
Discussion
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