A few weeks ago, I went to my local hospital for a skin biopsy on the red lump that had developed on my forehead over the course of the last three years. To have lived with a diffuse scleroderma diagnosis for 19 years, and to have not had to have a skin biopsy is, I know, very lucky. I wrote about this experience here.
Being a long-term diffuse scleroderma patient, I have, reluctantly, become resigned to the fact that my daily reality is to manage my symptoms to an optimum level, in the hope of getting through the day with as much ease as possible. I detailed more about this here.
Due to a diffuse scleroderma diagnosis bringing along a multitude of medical symptoms, crossing over into differing medical specialities, I try to prioritize and minimize my medical appointments; otherwise, I would be attending a medical appointment every day! I detailed my annual check-up tests here.
And so, after procrastinating for three years, I finally ‘braved up’ and had the biopsy. The results of which, after 10 days, concluded that an ‘actinic keratosis’ was the source of my red lump. I am scheduled to return to the skin clinic for treatment on this, the week before Christmas.
Actinic keratosis is caused by sun damage and could develop into any kind of skin cancer, including a squamous cell carcinoma. I also have a patch of Bowen’s disease on my left leg, which is also thought to have been caused by sun damage. I have cream to apply on the area — another task to add to the daily list for symptom control.
Increased risk of scleroderma and cancer
In 2012, a scientific medical paper titled “Systemic sclerosis (scleroderma) and cancer risk: systematic review and meta-analysis of observational studies,” published in Rheumatology, concluded, “There is an increased risk on the association between scleroderma and cancer.”
The results showed: “The association is fairly specific, since lung cancer and, to lesser extent, haematopoietic cancers were significantly increased in scleroderma patients, while breast cancer, although suggested by previous epidemiological investigations, was not associated with scleroderma.”
The study highlighted several difficulties with its design, including the use of immunotherapies, and that information on scleroderma subtype and organ-specific involvements could not be considered.
Further difficulties included: “The time relationship between clinical onset of scleroderma and diagnosis of malignancy, a crucial issue to understand possible underlying mechanisms, has not always been reported, and several investigations also included cancer cases ascertained within the first year after the diagnosis of scleroderma, which were more likely to be concomitant than subsequent diseases, leading to potential overestimate of summary risk. However, the sensitivity analyses excluding the latter studies showed significant, albeit slightly lower, increased risks for all and specific cancer sites explored, anyway.”
It continued: “The implications of this study are 2-fold. First, active surveillance of scleroderma patients for early detection of cancer is advisable and, with regard to the lung, specific guidelines would be welcomed to define modalities and timing of the screening with the benefit of a periodic CT scan of the lung, outweighing the risk posed by radiation. Secondly, alkylating agent should be used judiciously since they may predispose to cancer patients with an already fragile genome. Cyclophosphamide has been linked to increased risk of malignancy in patients with RA and systemic vasculitis.”
On a personal note, although I am trying to not have a heavy heart due to another Christmastime being sabotaged by another Scleroderma ‘Added Extra,’ I take huge comfort in knowing that Dr. Tiberiu Bontea and my skincare medical team are experts in their field — with plans of becoming a national skin center of excellence in fruition.
Living the dream, scleroderma style…
Note: Scleroderma News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Scleroderma News, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to scleroderma.