# A lesion in two: Buruli ulcer and squamous cell carcinoma coexistence

## TL;DR

This paper reports the first case where Buruli ulcer and squamous cell carcinoma coexisted, highlighting the need for careful diagnosis in similar cases.

## Contribution

The paper presents the first documented case of concurrent Buruli ulcer and cutaneous squamous cell carcinoma in Australia.

## Key findings

- Buruli ulcer and squamous cell carcinoma can coexist in the same skin lesion.
- Unusual lesion locations or treatment resistance may indicate an underlying malignancy.
- Biopsy and PCR testing are recommended for accurate diagnosis in such cases.

## Abstract

The concurrent diagnoses of Buruli ulcer (BU) and cutaneous squamous cell carcinoma (SCC) is a phenomenon not previously described, despite the fact that both conditions are highly prevalent in Australia. This report presents an intriguing case of concurrent diagnoses, with clues alluding to more than one skin condition being present. The case involves a 73-year-old man with BU diagnosed on the scalp, an atypical location, which led to the consideration of malignancy, ultimately revealing concurrent SCC. This case highlights the importance of considering both conditions in patients with epidemiological risk factors, necessitating multiple lines of investigation for accurate diagnosis. Medical practitioners must remain vigilant and incorporate this possibility into their diagnostic algorithms for suspicious skin lesions to optimize treatment and outcomes. This is the first recorded instance of simultaneous diagnosis, underlining the need for enhanced awareness and attention to these unique cases.

Buruli ulcer (BU) and squamous cell carcinoma (SCC) can coexist in the same lesion.SCC and other cutaneous malignancies may act as a portal of entry for the mycobacteria.Clinical differentiation is challenging, and biopsy should be performed, with tissue sent for histopathological evaluation as well as Mycobacterium ulcerans PCR.Consider the possibility of underlying malignancy if a Mycobacterium ulcerans lesion occurs in an unusual body site (for example: on the scalp) or does not heal as expected, despite appropriate treatment.

Buruli ulcer (BU) and squamous cell carcinoma (SCC) can coexist in the same lesion.

SCC and other cutaneous malignancies may act as a portal of entry for the mycobacteria.

Clinical differentiation is challenging, and biopsy should be performed, with tissue sent for histopathological evaluation as well as Mycobacterium ulcerans PCR.

Consider the possibility of underlying malignancy if a Mycobacterium ulcerans lesion occurs in an unusual body site (for example: on the scalp) or does not heal as expected, despite appropriate treatment.