A Case of Multiple Primary Squamous-Celled Carcinomata of Skin in a Young Man

Abstract

A case report is presented of a man with primary squamous carcinoma of the skin. After excision of the primary lesion the man healed with no recurrence reported. It is not impossible that some of the cases of primary epithelioma which are diagnosed clinically, excised, proved histologically and cured permanently, are examples of the condition described here, and if they had been left to develop naturally, they would have gone through the series of changes, ending in spontaneous cure.

Case Details

Personal Characteristics

William a, aged 23 years, miner, well-built and healthy-looking young man, never previously suffered from any disease of the skin

Clinical Characteristics

Spots began to appear on his legs, at first reddish macules, then became papular, enlarged, ulcerated, and ultimately healed, leaving pitted scars, individual lesions lasted for months, fresh ones appeared in numbers rather more than sufficient to balance the healing, lesions on his knees prevented him from kneeling, numerous peculiar lesions, which are seen in all stages of development, lesions commence as minute reddish papules, their centres become ulcerated with irregular, rolled edges, deep, pitted scars, with irregular, overhanging, crenellated borders, lesions on the legs are of similar type, but much larger size, many irregular depressed scars, some showing recurrent nodes, epidermal bridges, seen in the scars, prominent lesion on the antero-external aspect of the right leg, circular about 4 centimeters in diameter, raised about 1 centimeter above the normal skin level, has a fungating centre, and exudes a thin, ichorous fluid, trunk is completely free, skin apart from the actual lesions and scars is moist, supple, has a good hair-growth, and is in every respect that of a healthy young man, cultures from several lesions yielded on b. Proteus and enterococcus, wassermann reaction negative, general medical examination revealed nothing abnormal, most of the lesions have run a slow course in the direction of healing, one on the face, observed from start to finish, lasted for six months, and left a typical scar, many have lasted much longer than this, the prominent lesion on the right leg extended to form a patch 9 x 7 centimeters, the centre flattening out and healing, and the raised margin gradually subsiding, it now (march 2nd, 1934) shows little sign of activity, a few new lesions have appeared on his neck, and are growing very slowly, if at all, one recent one on the back of the hand and one on the calf have been excised, and have not recurred, five biopsies have been done so far

Remission Characteristics

Lesions ultimately healed, leaving pitted scars, most of the lesions have run a slow course in the direction of healing, one on the face, observed from start to finish, lasted for six months, and left a typical scar, many have lasted much longer than this, the prominent lesion on the right leg extended to form a patch 9 x 7 centimeters, the centre flattening out and healing, and the raised margin gradually subsiding, it now (march 2nd, 1934) shows little sign of activity, a few new lesions have appeared on his neck, and are growing very slowly, if at all, one recent one on the back of the hand and one on the calf have been excised, and have not recurred

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

One recent one on the back of the hand and one on the calf have been excised, and have not recurred, five biopsies have been done so far

Additional Notes

The patient's skin, apart from the actual lesions and scars, is described as moist, supple, with a good hair-growth, and in every respect that of a healthy young man. Cultures from several lesions yielded on B. proteus and enterococcus. Wassermann reaction was negative. General medical examination revealed nothing abnormal.