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Chromoblastomycosis Leading to Squamous Cell Carcinoma: An Overlooked Outcome of a Neglected Tropical Disease
Dallas J Smith1, Marlous L Grijsen1, Omayra Chincha1
1Dallas J. Smith is from the Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia. Dr. Grijsen is from the Oxford University Clinical Research Unit Indonesia and the Faculty of Medicine, Universitas Indonesia, Jakarta, and the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom. Dr. Chincha is from the Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, and the Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru. Dr. Hay is from King's College, London, United Kingdom. Dr. Pedrozo e Silva de Azevedo is from the Department of Medicine, Federal University of Maranhão, São Luís, Maranhão, Brazil, and the Post-graduation Program in Health Sciences, Federal University of Maranhão, São Luís.
Abstract:
Chromoblastomycosis is a neglected tropical skin disease acquired through traumatic inoculation of dematiaceous fungi. It is characterized clinically by a chronic granulomatous infection of the skin and subcutaneous tissue. Delays in diagnosis and limited access to antifungal therapy contribute to prolonged disease, recurrent inflammation, and debilitating sequelae. A rare but devastating complication is squamous cell carcinoma (SCC) associated with long-standing lesions, which may necessitate extensive surgery or amputation and can be fatal. In this review, we summarize reported epidemiology and clinical risk factors for SCC complicating chromoblastomycosis. We also discuss plausible inflammatory mechanisms of malignant transformation and propose pragmatic clinical and public health interventions, including decentralized microscopy-based diagnosis, timely antifungal access, and biopsy-triggered surveillance of chronically inflamed lesions, to reduce preventable morbidity.
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