Dhoti cancer: a waistline skin cancer with review of literature

Abstract

Skin cancers account for less than 1 % of all malignancies in India. Squamous cell carcinomas occurring over the waistline due to tying of cotton cloth called dhoti in males and sarees in females are predominantly seen in traditional Indian population. On wearing of these clothes for years, there is a constant irritation which produces depigmentation, glazing of the skin, acanthosis, scar formation, and later on malignant transformation. Presenting a case of a 65-year-old male with 7 × 5 cm ulceroproliferative growth over the right waistline with a history of prolonged use of dhoti. Wide local excision of the growth with 2-cm margin and primary closure of wound by mobilizing the skin was carried out. Histopathology showed well-differentiated squamous cell carcinoma. The patient is clinically disease free after postoperative follow-up of 1 year.

Dhoti cancer revisited

“…Dhoti is worn in a typical fashion with the knot tightly placed on waist with one of the shorter ends goes below the groin and tucked at the back [Figure 1]. [2] The tight knot at a constant position daily along with the perspiration that is so classic of the Indian subcontinent produces dermatoses. [6] These dermatoses may be considered the premalignant lesion that later on turns into frank malignancy.…”

“…However, it is commonly believed to be a variant of scar cancer. [2] Squamous cell carcinoma developing in a scar was first described by Marjolin in 1828. [2] The continuous friction on the skin produces hypopigmentation, acanthosis, and scar formation.…”

“…[2] Squamous cell carcinoma developing in a scar was first described by Marjolin in 1828. [2] The continuous friction on the skin produces hypopigmentation, acanthosis, and scar formation. This is evident on the left waist of our patient where malignancy developed [Figure 2].…”

“…[1] In India, skin cancers constitute less than 1% of all cancers. [2] Saree and dhoti [Figure 1] are traditional Indian dresses worn by females and males, respectively, to cover the lower parts of the body. These are particularly used as daily costumes in the Indian subcontinent due to comfort and low cost of cotton fabric.…”

“…[3] It is a type of waistline SCC reported in Indian males wearing dhoti . [2] It can be considered a variant of scar cancer as described by Marjolin. [4] Only a handful of cases are reported in the English literature, and the knowledge of its existence is even rare in Indian medical fraternity.…”