In the latest issue of the journal BMJ Case Reports, doctors offer a sobering warning: Tight waistbands worn under saris, especially in rural India, may cause a malignant tumor known as "petticoat cancer." The finding came after treating two women with such tumors.

The researchers said the constant pressure and friction on the skin can cause chronic inflammation, which can lead to ulcers and, in some cases, skin cancer. The phenomenon has previously been described as "sari cancer", but the researchers stressed that tight belts are the main problem.

The first case reported involved a 70-year-old woman who sought medical help for a painful ulcer on the right side of her abdomen. The ulcer had persisted for 18 months and had not healed. A biopsy specimen showed that she had a Marjolin ulcer, also known as squamous cell carcinoma. The second patient was a woman in her 60s who had an ulcer on the right side of her abdomen that had not healed for two years. A biopsy specimen showed that she also had a Marjolin ulcer.

Marjolin ulcers are rare but aggressive and often occur in chronic burn wounds, non-healing wounds, leg ulcers, tuberculous skin nodules, and vaccination and snake bite scars. The researchers explain that although many theories have been proposed, the specific process by which chronic ulcers or wounds become malignant is still unclear. Studies have shown that skin lesions that are continuously irritated (chronically inflamed) are at a higher risk of becoming malignant.

The researchers recommend wearing a loose petticoat under the saree to reduce pressure on the skin and, if a skin problem develops, wearing loose clothing to allow the area to heal. Talking about her diagnosis, the 70-year-old said: "I have worn Nauvari saris that were tied tightly around the waist for most of my adult life. Six years ago, I noticed a small area of depigmentation on the right side of my body, which I initially thought was just a minor skin problem. Over time, the spot turned into an ulcer that would not heal, causing me concern and discomfort. This discomfort became a part of my daily life, affecting my ability to perform daily tasks. When I finally consulted a dermatologist, I was diagnosed with skin cancer, which was exacerbated by chronic friction and pressure caused by the saree tied tightly around the waist."

"This has been an extremely difficult journey, both mentally and physically. It demonstrates the importance of paying attention to chronic skin changes and seeking medical advice early," she stressed. "I hope my story will raise awareness among women about the potential health risks of traditional clothing practices and encourage them to seek medical advice for unusual skin conditions."

This study was published by the BMJ Group and in the journal BMJ Case Reports. Details of the study can be found in the journal reference: Rusia, K. et al (2024). Petticoat cancer: Marjolin ulcers (a site-specific malignancy) on the lumbar region in South Asian women. BMJ Case Reports. doi.org/10.1136/bcr-2024-262049.