Coexistence of Favre-Racouchot disease, cutis rhomboidalis nuchae and skin neoplasms

Almost one fourth of the Polish population use tobacco products every day (30% of men and 21% of women) [1]. It is one of the most documented carcinogenic factors and it harms nearly every organ in the body. The skin manifestations of tobacco usage include yellow discoloration of fingernails, oral and gingival pigmentation, black hairy tongue, precocious skin aging and skin cancers [2]. Chronic ultraviolet exposure could also have a devastating effect on the skin leading to skin aging and cutaneous carcinogenesis [3]. The association of chronic tobacco usage with other skin damaging factors, like ultraviolet radiation, may cause extreme skin changes. We present an accumulation of skin disorders in a heavy smoking farmer, who due to his outside work was regularly exposed to sunlight, suffering from Favre-Racouchot disease (FRD), cutis rhomboidalis nuchae and skin carcinomas. The occurrence of all the above-mentioned diseases have a strong correlation with both UV radiation and smoking.
A 70-year-old Caucasian man was admitted to our department for the treatment of squamous cell carcinoma (SCC). Besides the ulceration on the lower lip, he complained of recurrent bilateral lesions on the face and increased marking of the skin on the neck. The lesions were not associated with any sensation, like pain or itch, but their increasing number started to make the patient concerned. He had no comorbidities. All his life he worked as a farmer and was a heavy cigarette smoker with 80 pack years. A year and a half before he had undergone an excision procedure of basal cell carcinoma (BCC) on his left temple area.
On admission, psychical examination revealed bilateral comedones on the man’s cheeks with multiple black- and whiteheads (Figure 1 A), an ulceration on the lower lip (Figure 2 A), telangiectasias, and generally damaged skin. Additionally, his bulbous nose was erythematous, with multiple yellow papules, nodules and cystic lesions. The skin on the patient’s neck presented deep wrinkles and leathery texture (Figure 2 B). The treatment consisted of surgical excision of the lip ulceration and extraction of bilateral comedones. The shave biopsy of the biggest nose lesion was taken to exclude possible rosacea. In the histopathological examination of the biopsy, structures resembling epidermal cyst were found (Figure 1 B), while examination of the ulceration confirmed SCC cut out with negative margins. The lymph nodes ultrasonography did not show any...


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