Aggressive Cutaneous Squamous Cell Carcinomas Following Treatment for Graft-versus-Host Disease: A Case Report and Review of Risk Factors

Abstract

A 19-year-old female with a history of pre-B cell acute lymphocytic leukemia (ALL) presented with two aggressive cutaneous squamous cell carcinomas (C-SCC) in the right hand. The patient was diagnosed with pre-B cell ALL at four years of age. She underwent chemotherapy with initial remission. However, recurrence of the pre-B cell ALL required an unrelated allogeneic cord hematopoietic stem cell transplant (alloHSCT). Post-transplant, the patient developed Graft-Versus-Host Disease (GVHD), which was treated with immunosuppressant therapy for six years until resolution. Fourteen years following the transplant, the patient developed a morbilliform drug eruption secondary to clindamycin. She consequently received prednisone treatment. During the treatment period, the patient developed a new ulcerated and tender nodule on the dorsal aspect of her right hand. Further histopathological biopsy confirmed the diagnosis of C-SCC, which required excision. Ten months following the excision, the patient developed an additional C-SCC nodule on the same right hand, separated by 2.6 cm from the prior C-SCC. She was referred for a ray resection procedure. This case illustrates a patient with multiple risk factors that may have contributed to the continued development of C-SCC. Such risk factors include: a prolonged course of immunosuppressant medications and voriconazole treatment. Additional research is needed to investigate the etiologies and risks of C-SCC development in patients who require a transplant and long-duration immunosuppressive therapy.

Characterizing the cutaneous late effects of allogeneic hematopoietic stem cell transplantation: A systematic review

“…Among studies that exclusively included pediatric HSCT recipients, the total number of participants was 6209, with 18 developing skin cancers 8,23–25 . In addition, three case studies reported a total of six pediatric HSCT recipients who developed skin cancers, resulting in a total of 67 pediatric HSCT recipients who went on to develop a form of skin cancer 26–28 …”

“…There were a total of 32 SCCs, followed by 25 BCCs, 3 melanomas, 3 Kaposi sarcomas affecting the skin, 1 Merkel cell carcinoma, and 1 myxofibrosarcoma. Of the six cases where body sites were reported, skin cancers were observed at the following sites: Kaposi sarcoma (abdomen, face, and upper and lower limbs) with positive immunohistochemical staining for human herpesvirus‐8 26 ; SCC in situ on the left cheek 28 ; nodular‐type and superficial‐type SCC in the nasolabial fold 28 ; SCC in situ on the left temple and hand lesions 28 ; two aggressive SCCs on the dorsum of the right hand 27 ; and one SCC on the left leg 28 …”

“…SCC in situ on the left cheek 28 ; nodular-type and superficial-type SCC in the nasolabial fold 28 ; SCC in situ on the left temple and hand lesions 28 ; two aggressive SCCs on the dorsum of the right hand 27 ; and one SCC on the left leg.…”

“…8,[23][24][25] In addition, three case studies reported a total of six pediatric HSCT recipients who developed skin cancers, resulting in a total of 67 pediatric HSCT recipients who went on to develop a form of skin cancer. [26][27][28]…”

A Group Contribution Analogy as Selection Criteria for Nutrients Fermentation Media in the Production of Tacrolimus, Sirolimus and Ascomycin

“…In addition, tacrolimus (Fig. 1), is recommended for the treatment of autoimmune diseases, rheumatoid arthritis, and lichen planus [5], as well as in bronchial asthma treatments, dermatological disorders as vitiligo, psoriasis, atopic dermatitis [6], eye diseases like uveitis [7], and retinoblastomas [8].…”