The purpose of this website does not include detailed discussion of cutaneous malignancies, however a few important features of endometriosis and conversion to malignant lesions, or co-occurrence of skin cancers as well as, the diagnosis of endometriosis and risk to develop skin cancer are discussed.
A very, very small portion of those with endometriosis have cutaneous lesions. Among these persons, only a minute portion (abt. 1%) will develop lesions which transform into one of the three skin cancers. (1-6) It is important to also recall, some with cutaneous lesions do not have endometriosis anywhere else in the body (link here: Cutaneous Endometriosis .)
A risk for development of skin cancer is not only present among those with cutaneous lesions, but all persons with a diagnosis of endometriosis of other body systems whom have an increased risk to develop skin cancer. (7,8)
First, its important to review the ABCDE’s for Skin Cancers that every person should regularly check their skin, not just the arms, legs and face, but also the front and back torso, even if you always cover up!
The ABCDE’s of Skin Malignancies
A: Asymmetry of border
B: Border around lesion is not consistent
C: Color of lesion is not uniform
D: Diameter across lesion is > 6mm.
E: The lesion has changed appearance (grown in size, changed color and/or shape)
A person does not have to have ALL (5) of these, and bleeding from the lesion to justify a visit with the doctor. Any changes are important. Taking photographs and writing measurements down of lesion size to compare them over time is a helpful way to document changes the physician can see.
Types of Skin Cancers:
Basal Cell Carcinoma:(9)
Most common type of skin cancer. Flesh to pearl color bump or pinkish patch of skin.
Squamous Cell Carcinoma:(9)
Second most common type of skin cancer. Firm red bump or recurrent scaly patch that never heals.
Deadliest form of skin cancer. Develops in a pre-existing mole or a new dark spot on the skin.
Endometriosis and Malignant Skin Cancer
The focus now turns to two separate aspects of endometriosis and skin cancer: a.) lesions of the skin that transform into malignant cancer and b.) a diagnosis of endometriosis anywhere in the body and risk of skin cancer.
Some skin lesions characteristically bleed. Not all skin lesions are malignant, some are benign, however, it is very important to seek medical attention early to rule out the presence of a cancerous (malignant) lesion.
Cutaneous Endometriosis (CE) and Malignant Conversion to Skin Cancer:
Note that the cutaneous endometriosis lesions did not transform into ANY of the above three primary skin cancers. The tissue of endometriosis lesions are similar to that of the endometrium of the uterus. As such, Clear Cell Carcinomas (aka Clear Cell Adenocarcinoma’s) and Endometriod Carcinomas (aka Endometriod Adenocarcinomas) are usually found among the female genital tract. (10)
Clear Cell Carcinomas have been reported within endometriosis lesions within cesarean scars (1,2,4-6), laparoscopic incision scars for treatment of Ovarian endometrioma (5) and umbilical incisional endometrioma following laparoscopic treatment for uterine myoma (fibroid)(3). All women in these cases were over 40 yrs of age with remote time from origin of surgical scar. (1-6)
Endometriosis Diagnosis (not isolated to cutaneous endometriosis) and Risk of Skin Cancers:
What is the probability that a person with endometriosis (anywhere in the body) will develop malignant skin cancer?
Is one form of skin cancer more likely to develop than others?
Only a few large studies have investigated this relation, but is has prompted recent interest in a possible of a shared develop pathway of both diseases. The first large study to determine any relation between skin cancer and endometriosis was published in 2007. (7) A sample of 98,995 women between the age of 40 and 65 years were assessed for presence of endometriosis and melanoma (a specific form of skin cancer). Among the participants, 16.6% reported endometriosis (5,949). The risk of concurrent melanoma among those with endometriosis was 1.62 in comparison to those without endometriosis. Those with endometriosis diagnosis had a 62% increased risk of developing melanoma compared to those without endometriosis (93,046). Although a significant relationship was found between having natural red hair and endometriosis, no significant increased risk of melanoma was found among naturally red haired persons with endometriosis. (7)
“Endometriosis and melanoma may thus share a common etiological genetic aspect(s), and the results we observe may only be a reflection of correlated factors”
“Because this disease appears to be a risk indicator for cutaneous melanoma, gynecologists may play a role in melanoma prevention by alerting patients with endometriosis of their higher susceptibility to the disease” – Kvaskoff M. et al (2007)
A decade later, the same group of women were further assessed for all three forms of skin cancer (melanoma, basal cell carcinoma and squamous cell carcinoma). The same group of women from the 2007 study in France were further assessed. Although the risk for melanoma was significant among those with endometriosis, the risk for both basal cell carcinoma and squamous cell carcinoma was not higher among those with a endometriosis diagnosis. (8)
“…women with endometriosis reported higher risk of ovarian, breast and melanoma cancers”
“It is currently unclear whether the reported association between endometriosis and melanoma risk reflects common associated factors between the two diseases, such as shared environmental, genetic, or hormonal history, or if it reflects systemic changes to the hormonal or inflammatory milieu caused by endometriosis” – Farland LV et al. (2017)
If a cis-female person has a 1st degree relative (parent, brother or sister, children given birth to) with history of melanoma could this determine the probability a cis-female’s probability of developing endometriosis? The results from a study which followed 116,430 women (aged 25-42 yrs) over 20 years, concluded the risk was ‘slightly elevated’ to develop endometriosis but those with ‘moles’ on the lower legs and/or increased sensitivity to the sun had significant probability of endometriosis. (11)
Although the study discussed was a very large sample size of 98,995 women the results numerous large scale studies in other regions of the world and age groups must be gathered. All their results then pooled together. The more large studies gathered, the more valid the findings can be applied as representative of the real relationship between endometriosis and melanoma and personal characteristics (age, region, genetic and/or environmental factors etc).
Melanoma and Endometriosis:
Unlike cutaneous endometriosis lesions, (comprised of tissue similar to the endometrium of the uterus) and explains the rare occurring transformation of skin endometriosis lesions into Clear Cell Carcinomas and not one of the three primary skin cancers (Basal Cell Carcinoma, Squamous Cell Carcinoma or Melanoma), those who develop melanoma and have a concurrent diagnosis of endometriosis, the skin malignancy does not evolve from the presence of a endometrioma in the skin.
Melanoma of the skin is the result of former ‘freckles’ or ‘moles’ which transform into malignancies. (9)
Melanoma’s most common origins (Primary) are the skin, uveal (eye), hard palate (roof of the mouth) and vulva (external genitalia area of females). However, the uterus is also a location in which melanoma can originate from (primary) or metastasize to (secondary site). (12)
The Washington Post printed a short article about Endometriosis and Melanoma (January 2019). Click here to read: “With some ailments, a second ‘partner’ illness may follow”.
All Rights Reserved © 2019 Wendy Bingham, DPT Extrapelvic Not Rare