BMJ GroupNov 5 2024
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.
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.
This phenomenon has previously been described as "saree cancer," but it is the tightness of the waist cord that's to blame, they point out.
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, tuberculous 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 add: "Constant pressure at the waist often leads to cutaneous atrophy, which ultimately breaks down to form an erosion or an ulcer. The ulcer at this site does not heal entirely due to ongoing pressure from tight clothing. A chronic non-healing wound results, which may develop malignant change."
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.
Commenting on her diagnosis, the 70 year old said: "I have been wearing a Nauvari saree, tightly wrapped around my waist, for most of my adult life. Six years ago, I noticed a small area of depigmentation on my right flank, which I initially dismissed as a minor skin issue.
"Over time, this spot turned into a non-healing ulcer, causing me concern and discomfort. The discomfort became a part of my daily life, impacting my ability to perform routine tasks. When I finally consulted a dermatologist, I was diagnosed with skin cancer, mostly exacerbated by the chronic friction and pressure from the tightness of the saree tied around my waist.
"This has been a psychologically and physically taxing journey. It shows the importance of paying attention to chronic skin changes and seeking medical advice early. I hope my story will raise awareness among women about the potential health risks associated with traditional clothing practices and encourage timely medical consultation for unusual skin conditions."
BMJ Group
Journal reference:
Rusia, K., et al. (2024). Petticoat cancer: Marjolin ulcer of the waist in South Asian women (a site-specific malignancy). BMJ Case Reports. doi.org/10.1136/bcr-2024-262049.