Cutaneous Squamous Cell Carcinoma in Patients with Hidradenitis Suppurativa

Abstract

Background: Cutaneous squamous cell carcinoma (cSCC) is a rare complication of hidradenitis suppurativa (HS). Objectives: To conduct a systematic review and an individual patient data (IPD) meta-analysis to describe the clinical characteristics of HS patients developing cSCC and determine predictors of poor outcome. Methods: Medline/PubMed, Embase, and Web of Science were searched for studies reporting cSCC arising in patients with HS from inception to December 2019. A routine descriptive analysis, statistical hypothesis testing, and Kaplan–Meier survival curves/Cox proportional hazards regression models were performed. Results: A total of 34 case reports and series including 138 patients were included in the study. The majority of patients were males (81.6%), White (83.3%), and smokers (n = 22/27 reported) with a mean age of 53.5 years. Most patients had gluteal (87.8%), Hurley stage 3 HS (88.6%). The mean time from the diagnosis of HS to the development of cSCC was 24.7 years. Human papillomavirus was identified in 12/38 patients tested. Almost 50% of individuals had nodal metastasis and 31.3% had distant metastases. Half of the patients succumbed to their disease. Conclusions: cSCC is a rare but life-threatening complication seen in HS patients, mainly occurring in White males who are smokers with severe, long-standing gluteal HS. Regular clinical examination and biopsy of any suspicious lesions in high-risk patients should be considered. The use of HPV vaccination as a preventive and possibly curative method needs to be explored.

Treating hidradenitis suppurativa in special populations: Pregnancy, lactation, and comorbid conditions

“…With 138 cases reported to date, cutaneous squamous cell carcinoma (SCC), is a rare, but potentially life‐threatening complication of long‐standing HS. It has been reported to mainly affect males who are smokers with chronic HS affecting the gluteal region 67 . The definitive mechanism behind the predisposition to SCC in HS is unknown.…”

“…In the case of HS, dysfunctional immune control manifests as chronic lymphedema and may play an important role in the development of SCC 68 . Smoking, chronic inflammation, and HPV infection are factors that are also thought to contribute to the risk of developing SCC in HS 67,69,70 …”

“…It has been reported to mainly affect males who are smokers with chronic HS affecting the gluteal region. 67 The definitive mechanism behind the predisposition to SCC in HS is unknown. A recent theory known as the "immunocompromised cutaneous district" states that chronically diseased regions of skin have dysfunctional immune control, thus predisposing the area of skin to an increased risk of malignant transformation.…”

“…68 Smoking, chronic inflammation, and HPV infection are factors that are also thought to contribute to the risk of developing SCC in HS. 67,69,70 HS should be diagnosed and treated as early as possible to avoid increased risk of malignancy, such as SCC. In cases where there is a high index of suspicion for malignancy, tissue samples should be collected early for definitive diagnosis.…”

Identification of hub-genes, lncRNAs, and skin cancer inducer genes through meta-analysis of Hidradenitis Suppurativa disease transcriptome data.

“…Although the molecular link between HS and overall cancer risk is recognized [10][11][12], the detailed molecular mechanism of cancer induction through this skin condition is a fascinating subject in disease and cancer care. Chronic in ammation and infections, which can lead to proliferative epidermal changes, could have begun the tumor [13,14].…”