Cutaneous-malignancy and leprosy. Report of a patient with Mycobacterium leprae and basal cell carcinoma concurrently present in the same lesion.

BACKGROUND: Leprosy is a chronic systemic infection caused by the bacillus Mycobacterium leprae. Cutaneous neoplasms have been observed in patients with leprosy. Also, albeit less commonly, M. leprae have been documented in the lesions of skin cancer. OBJECTIVE: To describe a 62-year-old man with chronic sun exposure and exposure to armadillos who subsequently developed lepromatous leprosy, to discuss the cutaneous malignancies that have occurred in patients with leprosy, and to review the literature concerning the concurrent presence of an infectious pathogen and a cutaneous neoplasm in the same lesion. METHODS: Our patient's basal cell carcinomas were excised, his abdominal plaques were biopsied, and his leprosy infection was treated with dapsone and rifampin. The types of cutaneous malignancies in leprosy patients and infectious pathogens concurrently found in lesions of skin tumors were summarized after evaluating previously published reports. RESULTS: Skin biopsies from our patient demonstrated M. leprae bacilli not only in his abdominal plaques, but also in all of his basal cell carcinoma lesions. Fungal, mycobacterial, and viral pathogens have concurrently been observed in skin lesions of basal cell carcinomas, Kaposi's sarcoma, melanoma, mycosis fungoides, and squamous cell carcinoma. CONCLUSION: Patients with leprosy can develop skin cancers and the histologic interpretation of those skin cancers can show evidence of leprosy. It is uncertain to what degree the decreased cell-mediated immunity in patients with lepromatous leprosy either enhances their susceptibility to and/or influences the course of their cutaneous neoplasms; also, in these patients, the coexistence of M. leprae organisms and cutaneous malignancy in the same lesion is likely to be secondary to the high bacillary load that is present.

Cancer associated with leprosy.

Eighty-seven leprosy patients with cancer, seen between 1960 to 1984, were studied. Cancer in patients with leprosy occurred in a younger age group compared to the general population. The most common type of malignancy seen among males was squamous cell carcinoma of the lower extremity while in hospital patient population it was cancer of head and neck. Among the females, carcinoma cervix was the most common as in the hospital patients. The types of malignancy occurring among leprosy patients was similar to that of the hospital patient population with the exception of an increase in incidence of squamous cell carcinoma of extremities.