Subfascial spread of advanced cutaneous squamous cell carcinoma

Abstract

We present a case of locally advanced cutaneous squamous cell carcinoma (cSCC) with subfascial spread, complicated by osteomyelitis but without metastasis. GP, a 60-year-old male, presented to our emergency department with complications of a septic wrist joint. He described a 3-month history of pain and an episode of 'explosive' purulent discharge, with subsequent development of multiple sinuses. He had a history of chronic sun exposure, with previous cSCC completely excised from the dorsum of his hand 3 years prior. On examination, he had multiple draining sinus tracts at the wrist (Fig. 1), and two leading edges of crusted lesions-overlying the dorsum of the proximal interphalangeal joints and proximal forearm (Figs. 2 and 3). Biopsies of these two leading edges showed welldifferentiated cSCC. The intervening skin was negative for dysplasia, showing only chronic dermal inflammation and fibrosis. He underwent debridement of his wrist and excision of the leading edges. Histopathology of the bone showed invasive SCC, with no overlying cutaneous involvement. PET scan demonstrated no metastatic disease. Bone cultures were positive for Staphylococcus aureus and