Squamous Cell Carcinoma Complicating Chronic Suppurative Hydradenitis

Abstract

A 69-year-old male patient underwent excision of hidradenitis suppurativa (HS) affecting both gluteal areas and the perineum. The perineal specimen contained a 1-cm superficially invasive, well-differentiated keratinizing squamous cell carcinoma. The patient was free of recurrence 1 year after surgery. A 66-year-old male patient was diagnosed with massive perineal HS more than 40 years previously. More than 30 abscesses and suppurative sinus tracts were surgically treated over the years. He eventually died of unresectable pelvic squamous carcinoma. Search of the literature and available bibliography revealed 47 retrospective studies of skin carcinoma arising in HS since 1959, including a total of 64 patients together with the two patients treated by our team. Squamous cell carcinoma is a rare but potentially fatal complication of HS. Surgery is the only known treatment method that provides a real chance for cure for both HS and a carcinoma that complicates it. HS must be treated early with complete excision to avoid chronic progression of the disease that can cause cancerous degeneration. A high index of suspicion, early tissue diagnosis, and immediate referral for radical surgery carry the only hope for cure in those whose HS harbors malignancy.

Squamous cell carcinoma of the vulva arising in the setting of chronic hidradenitis suppurativa: A case report

“…Frequently there is a delay in diagnosis of SCC and definitive surgical management. In a recent review of published cases of squamous cell carcinoma originating from HS/AI ( Losanoff et al, 2011 ), the majority of events were described in the context of long-standing, chronic HS/AI (20–30 years) with 50% mortality noted from metastatic disease. It is thought that infection with the human papillomavirus is a risk factor for the development of SCC in patients with HS/AI.…”

“…Pharmacologic methods include topical clindamycin as first-line therapy, topical resorcinol (a chemical peeling agent), intralesional corticosteroids or systemic antibiotics. The cases of chronic and severe HS/AI require a more aggressive approach to avoid the chronic progression of the disease; in these cases, early surgical treatment in the form of complete excision is often warranted when medical therapies fail ( Losanoff et al, 2011 ). Furthermore, a high index of suspicion and early tissue diagnosis should be performed in those with suspicion of malignancy.…”

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

“…Additional risk factors for development of NMSC include radiation therapy, lower Fitzpatrick skin types 1–4, prolonged immunosuppression, human immunodeficiency virus (HIV), human papilloma virus (HPV), and a diagnosis of certain syndromes or genetic disorders [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Unusual changes in peristomal skin of ileostomy and gastrostomy, burn scars, chronic inflammatory dermatologic conditions, and non-healing ulcers should also raise a suspicion for SCC, particularly Majolin’s ulcers [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Moreover, it has been well documented that male gender, tumor location in the trunk and extremities, superficial histologic subtype, younger age at first diagnosis of BCC, and red hair phenotype are associated with a higher risk of having multiple lesions [ 43 , 44 , 45 , 46 , 47 , 48 ].…”

γ-Secretase Mutations in Hidradenitis Suppurativa: New Insights into Disease Pathogenesis

“…Hidradenitis suppurativa (HS, acne inversa, OMIM142690) is a chronic inflammatory skin condition that presents with comedones, painful nodules, abscesses, and sinus tracts in apocrine gland-bearing areas. Longstanding disease can result in fibrosis, dermal contractures, significant scarring, formation of fistulae, and rarely malignant transformation to squamous cell carcinoma (Losanoff et al, 2011). HS most commonly affects the axillae, submammary folds, abdominal fold, groin, buttocks, and medial thighs.…”