Abstract

Saree cancer is a type of skin cancer that occurs along the waistline in females wearing the saree, caused by constant irritation which can result in scaling and changes in pigmentation of the skin. It is a rare type of cancer and generally found in the Indian subcontinent, where sarees are commonly worn by girls and women throughout their lives. It is similar to Marjolin's ulcer in cause, involving chronic inflammation.

Signs and symptoms

The foremost symptoms of saree cancer are the constant irritation with scaling and pigmentation change at the waistline; gradually these become chronic. The person may have non-healing ulcer or a hyper- or hypopigmented patch or a growth-like lesion over the waistline. The lesion may be associated with serous discharge with foul smell.

Cause

The saree is common female attire in the Indian subcontinent. It is a piece of long (generally ) cloth which can be made of various materials: cotton, silk, nylon, chiffon or synthetic fabric. It is worn over an inner skirt (petticoat) which is tightened around the waist by a thick cotton cord. This is the traditional costume of most Indian women. The saree is attached to the waist throughout the day in the hot and humid climate. The waist is often soiled with dust and sweat and remains without proper cleaning. This causes changes in pigmentation and mild scaling over the waist. This, in turn, causes chronic irritation and gradually malignancy may develop in the skin at the waistline.

Management

Excision biopsy is required to confirm the diagnosis of saree cancer. In many cases local excision with skin grafting is considered the appropriate treatment.

Different ways of wearing the petticoat may help saree-wearers to prevent saree cancer. Some such strategies are:

- Loosening the petticoat

- Changing the usual rope-like belt to broader ones that reduce pressure on the area

- Continuously changing the level at which the petticoat is tied

History of the disease

In 1945 physicians Khanolkar and Suryabai described a new type of skin cancer with hypopigmented and thickened scars which were more likely to progress into malignant lesions. They termed it "dhoti cancer", the dhoti being a traditional male costume of India which like the saree is wrapped around the waist. The term "saree cancer" was first used by a group of doctors led by Dr. A.S. Patil from Bombay Hospital, India, in the "Bombay Hospital Journal". The dermatological problem in the waist of Indian women wearing sarees had been recognised before by some other researchers. This type of cancer is now related to Marjolin's ulcer, the malignant degeneration of a chronic wound which was described by Jean-Nicolas Marjolin in 1828.