Flare-Up of Squamous Cell Carcinoma of the Skin following Fludarabine Therapy for Chronic Lymphocytic Leukemia

Abstract

We present a 72-year-old patient with chronic lymphocytic leukemia (CLL). About a year following therapy with chlorambucil and prednisone, he suffered from anemia, thrombocytopenia and organomegaly. The patient received fludarabine with a favorable response. Concomitantly with the clinical improvement of the CLL there was a remarkable flare-up of scalp squamous cell carcinoma (SCC) lesions, initially noted 4 years previously. The lesions were multiple and grew rapidly.

Trichoblastic Carcinoma (“Malignant Trichoblastoma”) with Lymphatic and Hematogenous Metastases

“…Various publications confirm an excess of Merkel cell carcinomas, basal cell and squamous cell carcinomas, and more aggressive variants of squamous cell carcinoma after non-Hodgkin's lymphoma (14 -16). Other secondary cancers, however, particularly noncutaneous cancers such as renal cell carcinoma and hepatocellular carcinoma, are related to therapy for the non-Hodgkin's lymphoma (17)(18)(19). Therapy-induced skin cancer can be ruled out in our patient as his B-CLL was not treated.…”

Skin cancer after nonmyeloablative hematopoietic cell transplantation

“…39,40 Larsen et al 41 reported metastatic SCC in one patient following treatment with fludarabine and in another after 2-CdA. Davidovitz et al 42 reported a patient with a flare of scalp SCC following treatment with fludarabine. Rashid et al 43 reported four patients who developed aggressive skin cancers (3 BCC and 1 SCC) following treatment with fludarabine.…”

Special Concern About Squamous Cell Carcinoma of the Scalp in Organ Transplant Recipients

“…Many of the immunosuppressive agents used in OTRs to prevent organ rejection have direct or indirect suppression of T-cell function. 7 Carucci et al 8 suggested that in-transit metastases tend to occur after high-risk SCC more frequently in OTRs than in patients who have not received transplants. They also noted that these in-transit metastases tended to occur after high-risk tumors of the forehead or scalp and were associated with a poor prognosis in OTRs.…”