Dhoti cancer: Case study of a waistline skin cancer with rev
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.

Patient gave history of tightly tying a cotton dhoti over the waistline for the last 40 years. On local examination, there was a hypopigmented skin patch with scaling and ulceroproliferative growth of 7 × 5 cm with everted edges (Fig. 1). Histopathology reports confirmed the presence of squamous cell carcinoma with tumor-free margin (Fig. 2). Postoperatively, the wound healed well without any complication, and the patient was discharged with a 3-month follow-up regime. After 1 year, locoregional recurrence was not observed on clinical evaluation.

Points to remember:-
1. The term dhoti cancer was coined in 1945 by Khanolkar and Suryabai which is a form of a waistline squamous cell carcinoma associated with wearing of dhoti by traditional Indian males.
2. Constant friction at the site of tying of dhoti or saree causes friction of the waistline which is associated with dermatoses.
3. The features of these skin cancers are similar to Marjolin’s ulcer, being slow growing and well differentiated and lymph node metastasis is rare and that too will occur if growth infiltrates the surrounding skin or underlying muscle when inguinal lymph nodes will get involved requiring wide excision of the skin with grafting and radiotherapy to inguinal lymph nodes along with chemotherapy.
4. Another important aspect is follow-up of other side lesion where a change of acanthosis was observed.
5. There is a need for an awareness drive for medical health providers and common public regarding these malignancies and regular screening of the waist skin of chronic dhoti users for any malignant transformation.

Source: https://wjso.biomedcentral.com/articles/10.1186/s12957-015-0698-z
Dr. S●●●●●●a R●y and 31 others like this12 shares
Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
Any extraordinary irritation predisposes the site to cancer; this is well established, isn' t it?
Dec 20, 2019Like
Dr. A●●●●r C●●●●●●●●●●●r
Dr. A●●●●r C●●●●●●●●●●●r General Medicine
Dec 23, 2019Like