Co esponding au ho : yous a elki ami
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
E ol ing pe ineal lesion in a smoking pa ien : Wha diagnosis o conside ?
Yous a elki ami , Rajae bounou , soukayna allali, Da Allah benajah, Sidi Adil Ib ahimi and Mohammed El
Abka i
Depa men o Hepa o-gas oen e ology, CHU Hassan II, Fez. Sidi Mohamed Ben Abdellah Uni e si y, Fez, Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 794-797
Publica ion his o y: Recei ed on 28 Ma ch 2025; e ised on 03 May 2025; accep ed on 06 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1711
Abs ac
Ch onic pe ineal lesions, especially when p og essi e and associa ed wi h weigh loss, should aise conce n o se ious
condi ions, pa icula ly malignancies. We epo he case o a 59-yea -old male, a ch onic smoke and egula cannabis
use , who p esen ed wi h a p og essi e ulce a i e pe ineal lesion e ol ing o e ou yea s wi hou medical e alua ion
and ea ed exclusi ely wi h adi ional emedies. Clinical examina ion e ealed a la ge, pain ul, in lamma o y
ulce a ion wi h nec o ic a eas. His opa hological analysis con i med a mode a ely di e en ia ed, in il a ing squamous
cell ca cinoma. S aging in es iga ions classi ied he umo as T4N1aM0 (s age IIIb). A di e ing sigmoidos omy was
pe o med, ollowed by concomi an chemo adio he apy. Clinical cou se was a o able, wi h ma ked symp oma ic
imp o emen and adiological eg ession o he umo mass. This case highligh s he impo ance o ea ly diagnosis o
suspicious lesions, pa icula ly in pa ien s wi h isk ac o s, and unde lines he c i ical ole o mul idisciplina y
managemen in imp o ing he p ognosis o pe ineal squamous cell ca cinomas.
Keywo ds: Pe ineal lesion; Squamous cell ca cinoma; Smoking; Ulce a i e lesion; Chemo adio he apy;
Mul idisciplina y managemen
1. In oduc ion
Ch onic pe ineal lesions a e pa icula ly conce ning due o hei po en ial se e i y. The p og essi e na u e o hese
lesions, especially when associa ed wi h weigh loss, immedia ely aises suspicion o se ious unde lying condi ions,
pa icula ly malignancies. Among he i s diagnoses o conside a e squamous cell ca cinoma and melanoma, wo
highly agg essi e cance s ha may p esen wi h simila ulce a i e ea u es. The po en ially li e- h ea ening na u e o
hese condi ions manda es ho ough and p omp diagnos ic in es iga ion.
The aim o his a icle is o p esen a clinical case o a pa ien wi h a p og essi e pe ineal lesion, highligh ing he clinical
indings and di e en ial diagnoses, wi h a pa icula ocus on he impo ance o conside ing malignan umo s.
2. Case p esen a ion
M . A.D., a 59-yea -old man, has a long-s anding his o y o hea y smoking (40 pack-yea s) and daily cannabis use. Fo
he pas ou yea s, he had been su e ing om a p og essi ely enla ging pe ineal ulce a i e lesion, associa ed wi h
se osanguinous discha ge and unquan i ied weigh loss. The pa ien had no sough any medical ad ice du ing his ime,
elying exclusi ely on adi ional ea men s.
Clinical examina ion e ealed a pa ien in gene ally good condi ion, wi h no palpable abdominal masses and no
lymphadenopa hy. P oc ological examina ion showed a la ge pe ineal issue loss, app oxima ely 4 cm in i s longes
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 794-797
795
dimension (Figu e 1), pain ul, wi h i egula bo de s, ma ked in lamma o y signs, and a nec o ic base in places
in e spe sed wi h b igh ed g anula ion issue.
A biopsy was pe o med, and his opa hological analysis e ealed a mode a ely di e en ia ed and in il a ing squamous
cell ca cinoma.
S aging in es iga ions showed a locally ad anced anal canal umo , classi ied as T4N1aM0, co esponding o s age IIIb.
The case was discussed in a mul idisciplina y umo boa d, whe e he decision was made o p oceed wi h a p o ec i e
in es inal di e sion (sigmoidos omy), ollowed by concomi an adiochemo he apy wi h luo opy imidines.
The clinical cou se ollowing ea men was ma ked by a signi ican imp o emen in he pa ien ’s gene al condi ion. He
became asymp oma ic, epo ing nei he pain no local discom o . On p oc ological examina ion, he anal ma gin
appea ed mos ly healed, as shown in Figu e 2. The p e iously ulce a i e and p oli e a i e lesion had eg essed
subs an ially. A esidual e y hema ous and indu a ed a ea emained nea he anal o i ice, wi hou signs o
supe in ec ion o bleeding. This appea ance sugges s a a o able clinical cou se, wi h ongoing healing unde ea men .
Radiologically, a ho aco-abdomino-pel ic CT scan showed eg ession o he anal canal umo . The igh inguinal lymph
nodes had dec eased in size, and he meso ec al lymph nodes we e eplaced by esidual lympha ic o ma ions. No
e idence o dis an ecu ence was obse ed.
Figu es 1 and 2 show he aspec o he anal ma gin be o e and a e adiochemo he apy, demons a ing clea local
imp o emen and eg ession o he lesion.
Figu e 1 Clinical appea ance o he anal ma gin p io o ini ia ion o chemo adio he apy
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796
Figu e 2 Clinical appea ance o he anal ma gin ollowing comple ion o chemo adio he apy
3. Discussion
Squamous cell ca cinoma is a ype o skin cance ha ypically a ises in sun-exposed a eas, bu i can also de elop in
less exposed egions such as he pe ineum [1]. Tobacco use is a well-es ablished isk ac o o many ypes o cance ,
including squamous cell ca cinomas [2, 4]. Fu he mo e, ch onic cannabis use may also con ibu e o he pa hogenesis
o such lesions, al hough di ec e idence emains limi ed.
The apid p og ession o he lesion and he absence o medical consul a ion o ou yea s led o a diagnosis a an
ad anced s age (T4N1M0), highligh ing he c i ical impo ance o ea ly de ec ion and managemen o suspicious
lesions. The p esence o nec o ic a eas and i id ed g anula ion issue wi hin he lesion is cha ac e is ic o in asi e
umo s [1, 3], ein o cing he need o agg essi e ea men and close ollow-up.
The p ognosis o squamous cell ca cinoma la gely depends on he s age a diagnosis and he umo ’s esponse o
ea men [3]. A mul idisciplina y ea men app oach including su ge y, adio he apy, and po en ially chemo he apy
is o en necessa y o manage he disease e ec i ely [3]. Regula moni o ing is c ucial o de ec any ecu ence o
me as asis.
4. Conclusion
This clinical case highligh s he impo ance o igilance ega ding p og essi e pe ineal lesions, especially in pa ien s
wi h isk ac o s such as smoking. Ea ly diagnosis and p omp in e en ion a e essen ial o imp o e su i al ou comes
and educe complica ions associa ed wi h pe ineal cance s. Regula medical consul a ions and he e alua ion o
cu aneous lesions—e en in less isible a eas—should be encou aged o enable ea ly de ec ion o malignan condi ions.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e ha hey ha e no compe ing in e es s.
S a emen o e hical app o al
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 794-797
797
E hical app o al was no equi ed o his case epo , as pe he policies o ou ins i u ion. The wo k complies wi h he
e hical s anda ds o he Decla a ion o Helsinki.
S a emen o in o med consen
W i en in o med consen was ob ained om he pa ien o publica ion o his case epo and any accompanying
images.
Re e ences
[1] Acke man, A. B. (2009). Ca cinoma o he Skin. In Acke man's Su gical Pa hology, 5 h Edi ion, pp. 707–732.
Else ie .
[2] G embowski, D., & Wagne , E. H. (2007). "Risk Fac o s o Squamous Cell Ca cinoma o he Skin." Jou nal o
De ma ological T ea men , 18(4), 215–222.
[3] Kawai, K., & I ami, J. (2012). "Managemen o Squamous Cell Ca cinoma o he Skin: A Re iew." Japanese Jou nal
o Clinical Oncology, 42(6), 489–494.
[4] Shapi o, M., & Smi h, S. (2018). "The Role o Tobacco in he De elopmen o Ca cinomas." Jou nal o Clinical
Oncology, 36(15_suppl), e19045
