Squamous Cell Carcinoma Complicating Discoid Lupus Erythematosus

A Chinese woman with a 12-year history of discoid lupus erythematosus (DLE) presented to our hospital v /̂ith two fungating tumors on her DLE lesions on both forearms. The tumors had started on each forearm as nodules that grew slowly over 6 months. There was no preceding history of trauma or ionizing radiation to the forearms. She was treated with topical steroids by her general practitioner earlier. Examination then showed DLE plaques on her forearms, dorsum of the hands, face, and legs. A fungating tumor (measuring 7 cm in diameter each) was present on DLE plaques on each forearm (Fig. 1}. Abnormal laboratory findings included raised ESR (70 mm/hr) and positive antinuclear antibody test (titer 1/20, homogenous nuclear pattern). Results of blood counts, direct Coomb's test, liver function and renal function tests, VDRL test, urinaiysis, and chest x-ray were normal. Wide excision of the tumors with a skin graft of normallooking skin taken from the covered parts of both thighs was done. Histology of the excised tumor showed well-differentiated squamous cell carcinoma with dense lymphocytic dermal infiltrate (Fig. 2). The skin surrounding the tumor showed characteristic lupus erythematosus changes with epidermal atrophy, vacuoiar basal cell degeneration, thickened basement membrane, periappendageal lymphohistiocytic infiltrates, and telangiectasia in the upper and mid-dermis (Eig. 3). Direct immunofluorescence studies were negative. Eight months after surgery, new DLE lesions developed on the grafted skin (Fig. 4), and a biopsy specimen showed similar changes of DLE. The patient was given oral chloroquine sulfate 450 mg daily, and the DLE lesions became less erythematous; some lesions healed with scarring and no new lesions appeared. Chloroquine was tapered over 2 years, and the patient remained fairly well with residual DLE plaques on her forearms.