BMJ Case Reports: Tight belts can lead to cancer, researchers warn

A tightly tied waist cord of the underskirt (petticoat) traditionally worn under a saree, particularly in rural parts of India, may lead to what has been dubbed “petticoat cancer,” warn doctors in the journal BMJ Case Reports after treating two women with this type of malignancy, BMJ Group reports.

The continued pressure and friction on the skin can cause chronic inflammation, leading to ulceration, and, in some cases, progression to skin cancer, say the authors.

The first case concerned a 70 year old woman who sought medical help because of a painful skin ulcer on her right flank that she had had for 18 months and which wouldn’t heal. The skin in the surrounding area had lost its pigmentation. She wore her petticoat underneath her saree which was tightly tied around her waist. A biopsy specimen revealed that she had a Marjolin ulcer, also known as squamous cell carcinoma (ulcerating skin cancer).

The second case concerned a woman in her late 60s who had had an ulcer on her right flank that wouldn’t heal for 2 years. She had worn a traditional type of saree called a “lugda” every day for 40 years, tied very tightly around the waist without an underskirt. A biopsy specimen revealed that she too had a Marjolin ulcer. The cancer had already spread to one of the lymph nodes in her groin when she was diagnosed.

A Marjolin ulcer is rare but aggressive. It develops in chronic burn wounds, non-healing wounds, leg ulcers, tuberculosis skin nodules, and in vaccination and snake bite scars, explain the authors

“The exact process by which chronic ulcers or wounds become malignant is unknown, although many theories have been proposed,” they write. “Every cutaneous lesion that is continuously irritated (chronically inflamed) has been shown to have a higher risk of developing malignant transformation.”

They recommend wearing a loose petticoat beneath the saree to ease pressure on the skin, and to wear loose clothing if skin problems develop to allow the area to heal.

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