May 16, 2014 - The second lesion presented an 8-mm in diameter round hyperkeratotic papula located on the dorsum of right hand (Figure 2a). Dermoscopic ...
Basal cell carcinoma and squamous cell carcinoma in a patient with Parkinson disease Hristo Dobrev (hristo_dobrev at hotmail dot com) #, Desislava Nocheva, Nina Vutova, Reni Hristova Department of Dermatology and Venereology, Medical University, Plovdiv, Bulgaria # : corresponding author DOI http://dx.doi.org/10.13070/rs.en.1.800 Date 2014-05-16 Cite as Research 2014;1:800 License CC-BY
Introduction Recently, the positive association between Parkinson disease (PD) and skin cancer was established. Studies had reported a 2-fold increase in the risk of melanoma and 20% increase in the risk of non-melanoma skin cancer in patients with PD [1]. Case presentation We describe a case of two non-melanoma skin cancers occurring in a 74-year-old man, with a 10-year history of PD treated with levodopa (L-dopa). He was referred to our Department of Dermatology on the occasion of starting new medication. On physical examination, two [enlarge] problem skin lesions with about 1-year duration were observed. The first one presented an 8-mm in diameter round, slightly infiltrated, pigmented lesion located on the right tip of the nose (Figure 1a). Dermoscopic features Figure 1. Basal cell carcinoma on the nose before treatment (1A), dermoscopy findings with consistent with pigmented immersion and 60x magnification (1B), and after treatment (1C). superficial basal cell carcinoma including teleangiectasia, arborizing vessels, pigment globules and dots, and featureless areas were observed (Figure 1b). Histological study of the lesion confirmed the diagnosis. Radiation therapy with excellent result was applied (Figure 1c). The second lesion presented an 8-mm in diameter round hyperkeratotic papula located on the dorsum of right hand (Figure 2a). Dermoscopic features consistent with squamous cell carcinoma including whitish structure less area and linear-irregular vessels were observed (Figure 2b). The lesion was surgically excised (Figure 2c) and the following histological study confirmed the diagnosis. Discussion [enlarge]
Several aspects of the association between PD and skin tumors could be discussed. Aspect 1. Parkinson disease and melanoma skin cancer.
Compared with general population, an increased prevalence of malignant melanoma in PD patients as well as an increased incidence of PD in patients with melanoma or family history of melanoma was observed [2]. It was supposed the existence of an identical etiological factor that leads to destruction of the substantia nigra and the malignant transformation of skin melanocytes [1]. Systematic reviews of the literature done by Zanetti and Rosso [3], and Liu et al. [4] confirmed the association between PD and a higher occurrence of melanoma, and suggested that it may be due to shared genetic or environmental risk factors or common pathogenic pathways. In addition, the genetic determinants of idiopathic PD could increase susceptibility of the skin to UV radiation [1].
Figure 2. Squamous cell carcinoma on the nose before treatment (2A), dermoscopy findings with immersion and 60x magnification (2B), and after treatment (2C).
Aspect 2. Parkinson disease, melanoma and L-dopa. J. Skibba (1972) first reported a case of recurrent malignant melanoma in a patient with Parkinson disease treated with levodopa. Since then, more than 50 similar cases were reported. That provide the occasion for formal contraindication for the use of L-dopa in PD patients with suspected or diagnosed melanoma as well as with history of melanoma [2]. Some authors consider this association to be possible because L-dopa is a substrate for the synthesis of dopamine and melanin and could stimulate melanogenesis [2]. According to other authors, L-dopa had no role in the induction of melanoma and the relationship is coincidental rather than causal [5]. Aspect 3. Parkinson disease and non-melanoma skin cancer. Studies have found an increased risk for neoplastic and pre-neoplastic lesions in PD patients. More cases of actinic keratosis (19%) and basal cell carcinoma (3%) were diagnosed in PD patients compared to age matched controls. It is hypothesized that PD patients are probably more sensitive to induced by sun-exposure skin lesions [2]. Recently, A. Hiraldo et al. [1] observed two consecutive melanoma lesions and multiple superficial basal cell carcinomas in a 42-year-old man, with 10-year history of PD, treated with levodopa. Here, we presented a patient with PD in combination with two non-melanoma skin cancers. Conclusions Our case substantiates the necessity of regular dermatological examination, including dermoscopy, in PD patients with the purpose of timely identification and optimal managing of neoplastic skin lesions.
References 1. Hiraldo A, Gómez-Moyano E, Martínez S. et al. Melanomas and Basal Cell Carcinomas in a Patient With Parkinson Disease. Actas Dermosifiliogr 2010, 101: 95-6. 2. Ferreira J, Neutel D, Mestre T, Coelho M, Rosa M, Rascol O, et al. Skin cancer and Parkinson's disease. Mov Disord. 2010;25:13948 pubmed publisher 3. Zanetti R, Loria D, Rosso S. Melanoma, Parkinson's disease and levodopa: causal or spurious link? A review of the literature. Melanoma Res. 2006;16:201-6 pubmed 4. Liu R, Gao X, Lu Y, Chen H. Meta-analysis of the relationship between Parkinson disease and melanoma. Neurology. 2011;76:2002-9 pubmed publisher 5. Fiala K, Whetteckey J, Manyam B. Malignant melanoma and levodopa in Parkinson's disease: causality or coincidence?. Parkinsonism Relat Disord. 2003;9:321-7 pubmed ISSN : 2334-1009
