Recurrent squamous cell carcinoma and a novel mutation in a patient with xeroderma pigmentosum: a case report

Abstract

Background Xeroderma pigmentosum is an extremely serious genetic disorder defined by sensitivity to sunlight, resulting in sunburn and pigment changes. If patients are not completely protected from ultraviolet radiation, xeroderma pigmentosum is characterized by a greatly increased risk of sunlight-induced cutaneous neoplasms. There is no standard therapy for skin cancer of xeroderma pigmentosum. However, immune checkpoint inhibitors were reported to increase response rates and improve outcomes and life expectancy in patients with various cancers, including squamous cell carcinoma in xeroderma pigmentosum. In this paper, we report on a patient with xeroderma pigmentosum from a consanguineous family with recurrent facial chemotherapy-resistant squamous cell carcinoma lesions treated successfully with an anti-programmed cell death protein 1 monoclonal antibody in both relapses. Case presentation A 7-year-old Turkish male was referred to our oncology department for recurring squamous cell carcinoma after local excision of the tumor over his nose. The lesion was a rapidly growing lesion, measuring 8 × 4 cm in size. Physical examination revealed that he also had hemorrhagic crusted plaques and nodules over both eyelids and upper lip, with multiple hypo- and hyperpigmented punctate lesions all over his body. After two more cycles of chemotherapy, progressive disease was noted, and a new lesion on the right eyelid caused blurred vision. Anti-programmed cell death protein 1 antibody treatment was planned with concomitant radiotherapy. He received nivolumab every 3 weeks for 4 months, improving his vision. No new lesions or active complaints have been observed in the current situation, and complete remission has been achieved. On the last admission, the patient was clinically diagnosed with xeroderma pigmentosum. Owing to the condition’s genetic heterogeneity, whole-exome sequencing was performed with Ion Proton next-generation sequencing platform, and the c.2250 + 1G>A splice site mutation of the XPC gene was detected in the homozygous state. Conclusions The clinical report emphasizes the importance of clinical awareness and crucial early diagnosis of xeroderma pigmentosum and presents a novel causative homozygous c.2250 + 1G>A splice site mutation. Our case proves that next-generation sequencing is an effective method for the rapid diagnosis and determination of xeroderma pigmentosum genetic etiology.

Retrospective study of efficacy and adverse events of immune checkpoint inhibitors in 22 xeroderma pigmentosum patients with metastatic or unresectable cancers

“…Eighteen months later, he developed a recurrence of cSCC on the neck and restarted ICI treatment. At the time of publication, the patient showed remission of the recurrent cSCC (28). Another XP patient showed remission of a metastatic melanoma treated with ipilimumab and regression of an unresectable maxillary sinus SCC treated with pembrolizumab.…”

“…Before ICI treatment, seven patients with metastatic melanoma (two patients), sarcomatoid carcinoma (one patient (23)), metastatic cutaneous SCC (cSCC) (two patients (27,28))), and unresectable or metastatic angiosarcoma (two patients (22,32) did not respond to treatment with cytokines, chemotherapy, radiotherapy, targeted antibody therapy (Supplementary Tables S1-S3). In contrast, all 22 patients in the study showed regression or remission of the target cancer in response to ICI (treatment duration ranged from 2 to 60 months) (Table 1).…”

“…Eight patients developed new localized, primary cancers (melanoma, basal cell carcinoma-BCC, SCC) during or after ICI treatment (Table 1). One patient developed new superficial lesions on the scalp, tongue, and right auricle after his first course of ICI (28).…”