Squamous cell carcinoma complicating a chronic lesion of hidradenitis suppurativa: a case report and review of the literature

Abstract

Squamous cell carcinoma (SCC) arising from chronic hidradenitis suppurativa (HS) is rare; however, the morbidity associated with this presentation is high and management has not been standardised or optimised. We present a case of HS of the perineum and buttocks complicated by SCC, requiring multiple extensive surgical resections. Adjuvant radiotherapy was withheld initially because of concern for poor healing of the surgical wound but was eventually initiated after a second recurrence was identified. The patient ultimately expired 4 years after the initial diagnosis of SCC. We also review 80 cases of SCC complicating HS found in the English literature. Case reports and mechanistic studies suggest the possibility that human papilloma virus and smoking may be risk factors associated with SCC in HS. Despite the majority of SCC cases being well-differentiated tumours in HS, the highly aggressive nature of SCC in HS and its high likelihood for rapid progression, recurrence, metastasis and high mortality suggests the need to advocate for aggressive treatment. We recommend an aggressive approach to management at the time of SCC diagnosis in HS, which includes appropriate imaging to establish the extent of the tumour, large and deep surgical excision, sentinel lymph node evaluation, consultation with radiation oncology for potential adjuvant radiation therapy and close surveillance.

Contribution of fibroblasts to tunnel formation and inflammation in hidradenitis suppurativa/ acne inversa

“…One of the most serious complications of long‐term HS is the development of aggressive, metastatic squamous cell carcinoma . Despite their well‐differentiated nature, these tumours rapidly metastasize and can be fatal.…”

Cutaneous squamous cell carcinoma complicating hidradenitis suppurativa: a review of the prevalence, pathogenesis, and treatment of this dreaded complication

“…Although rare, the development of squamous cell carcinoma (SCC) superimposed on chronic HS has a high morbidity. Studies have shown that long-lasting HS and the involvement of the buttocks and perineal areas increase the risk of malignant transformation to SCC (6,7). When SCC does arise in HS it is usually well differentiated; however, despite the theoretical good prognosis, the combination of SCC and HS is often associated with early metastasis and high mortality rates (8).…”

Fatal outcome of malignant transformation of hidradenitis suppurativa: A case report and literature review

“…A paper in 2016 by Jourabchi et al and in 2018 by Chapman et al described 80 and five cases, respectively, on SCC in patients with HS cases in the English literature. We found five additional cases of SCC arising from HS reported in the literature since the last updated review by Chapman et al (Table ).…”