BASOCELULAR CARCINOMA DEVELOPED ON VITILIGO BASOCELULAR CARCINOMA DEVELOPED ON VITILIGO FEKETE GYULA LÁSZLÓ 1, FEKETE JÚLIA EDIT 2, BAGOSI ÁGOTA 1, 1. UMF Târgu-Mureş, Dermatology Clinic 2. Regional Center of Public Health Târgu-Mureş Romania Vitiligo is a chronic disease, characterized by the appearance of depigmented, well defined macules, plaques or plackards. Even though there is no melanic pigment on the vitiligo plaques, that would protect the skin from harmful radiation, actinic keratosis seldom appears, and non-melanic forms of cancer are extremely rare. Basocellular carcinoma is the most common malignant tumor of the skin, representing 30% of all skin cancers and 60-80% of all skin carcinomas. The incidence of basocellular carcinoma is growing continuously. We would like to present the case of a patient who developed basocellular carcinoma (BCC) on a vitiligo plaque Clinical case We would like to present the case of a clinically healthy 36 year old patient from an urban backround, with phototype II. He sought medical help for a, slowly evolving, round-oval reddish peeling spot, with a diameter of about 1 cm, that first appeared 4 months previously on a vitiligo plaque. Clinical examination: on the left shoulder we found a chronically depigmented plaque of about 13x5cm on which there was a painless, reddish, oval-round spot, 1.5cm in diameter, with irregular borders and with a very slight margin. The plaque is peeling and has a central erosion. The presumptive diagnosis was that of a non-melanotic carcinoma, especially basocellular carcinoma.As a therapeutic measure the lesion was surgically removed and underwent histopathological examination.which confirmed the presumptive diagnosis

Clinical and histopatological aspect

DISCUSSION Considering the fact that patients with vitiligo don’t have any protective pigment on the affected areas, it would be expected that these should have a higher risk of non-melanotic carcinoma. Up to date, though, there is no clear proof that may conform this There is controversy in literature, referring to the increased risk of non-melanotic carcinoma among patients with vitiligo. [1,2] The appearance of spinocellular carcinoma was discovered mainly in the case of patients suffering from vitiligo, treated/untreated with PUVA on the long term. [2,3,4]. Schallreuter et al. evaluated 136 caucasian patients suffering from vitiligo and looked for direct association between this malady and non-melanotic skin cancer. Their results confirm the absence of an elevated risk for non-melanotic skin cancer in comparison with the healthy population, concluding that the appearance of skin cancer in patients with vitiligo is random. [5] Some authors associate the lack of sun-damage in vitiligo patients with an excessive activity of the tumor suppressing gene p53, that protects against basocellular carcinoma as well. [6,7]

DISCUSSION Pubmed database: the conclusions of 4 studies referring to the association of basocellular carcinoma with vitiligo [8,9,10,11]  The studies suggest the lack of elevated risk of basocellular carcinoma among vitiligo patients.  The appearance of basocellular carcinoma in vitiligo patients is extremely rare  There is no direct link between sun-exposure to the appearance of basocellular carcinoma on vitiligo plaques and placards. Conclusions There is no proof of sun-damage causing basocellular carcinoma on vitiligo plaques and placards. The appearance of basocellular carcinoma on vitiligo spots, plaques and placards is rare, the real incidence is unknown. The particularity of the case is the appearance of basocellular carcinoma on a vitiligo plaque in a young male patient who suffered chronic sun-damage.