Eruptive non-melanoma skin cancers/squamous atypia following skin surgery. Report of two new cases, concise review of the literature with special emphasis on treatment options

Abstract

Multiple eruptive cutaneous non-melanoma skin cancers(NMSCs) have been reported to arise at the sites of skin surgery, including the area affected by the primary tumour and split thickness skin graft(STSG) donor and recipient sites. The aim of this study is to make a critical revision of the literature, analysing the clinical, histological features and outcomes of eruptive NMSCs after cutaneous surgery. Up to August 2021, according to our systematic review of the literature, we have collected 18 published articles and a total of 33 patients, including our two cases. The results of this review highlight five red flags that clinicians should consider: (i) lower and upper limbs represent the cutaneous site with the highest risk, representing 82.35% of the cases in the literature; (ii) the median time to onset of eruptive NMSCs that is approximately 6 weeks; (iii) primary NMSCs were completely excised with free margins on histologic examination in all cases of the literature, and therefore the eruptive NMSCs reported could not be considered recurrences; (iv) any surgical technique involves a risk to promote eruptive NMSCs; (v) treatment of eruptive NMSCs includes surgery or combined surgical and medical treatment. However, eruptive NMSCs recurrences are a real medical challenge and have always been treated combining surgical and medical treatment, with complete resolution in about one third of patients. In conclusion, even though the pathogenesis remains unclear, this review highlights 5 red flags which could support clinicians in the diagnosis and management of eruptive of NMSCs after skin surgery.

Diffuse eruptive squamous atypia, also known as eruptive keratoacanthoma: Unique case presentation

“…These idiopathic, sometimes koebnerizing, proliferations are often misdiagnosed as SCC or keratoacanthoma-type SCC. 2 , 3 , 4 Here we report a unique case with an impressive presentation of D-ESA, initially misdiagnosed and treated with immunotherapy, which responded dramatically once recognized and treated as ESA.…”

“…However, synchronous eruption can also occur idiopathically. 2 , 4 , 5 This condition more commonly occurs in female patients, with an average age of 69 to 73.5 years. Patients with ESA have had previous keratinocyte carcinomas and may or may not have a history of immunosuppression; these new growths are frequently located on the bilateral lower and upper extremities.…”

“…Patients with ESA have had previous keratinocyte carcinomas and may or may not have a history of immunosuppression; these new growths are frequently located on the bilateral lower and upper extremities. 2 , 3 , 4 In cases of ESA following trauma, the time to onset can vary from 6 to 16 weeks. 2 In 2018 Que et al published an article with the first proposed clinical and histologic criteria and definitions as shown in Table I .…”

“… 2 , 3 , 4 In cases of ESA following trauma, the time to onset can vary from 6 to 16 weeks. 2 In 2018 Que et al published an article with the first proposed clinical and histologic criteria and definitions as shown in Table I . 3 …”

“…It is important to review this particular diagnosis so patients are accurately diagnosed and treated. 2 , 3 , 4 …”