Saree or petticoat cancer: Tightly tied waist cord of saree underskirt may lead to skin ulceration and pose cancer risk, warn doctors

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 two 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.

 Petticoat cancer: Marjolin ulcer of the waist in South Asian women (a site-specific malignancy), BMJ Case Reports (2024). DOI: 10.1136/bcr-2024-262049