Linear porokeratosis with multiple squamous cell carcinomas successfully treated by electrochemotherapy

Abstract

Porokeratosis is a clonal epidermal disorder of keratinization characterized by annular lesions with an atrophic centre and a hyperkeratotic edge. The cornoid lamella is the histopathological hallmark. Six clinical variants are recognized: porokeratosis of Mibelli; disseminated superficial porokeratosis; disseminated superficial actinic porokeratosis (DSAP); porokeratosis plantaris et palmaris disseminata; punctate porokeratosis and linear porokeratosis. Linear porokeratosis is the type most frequently associated with malignant transformation into squamous cell carcinoma (SCC). It is thought to represent a mosaic form of DSAP and has an incidence of less than 1 in 200 000; treatment options are limited. We describe a patient with systematized linear porokeratosis and multiple SCCs who was successfully treated with bleomycin electrochemotherapy (ECT), a form of intralesional chemotherapy. In view of their large number, the individual SCCs were treated with bleomycin ECT. One year post-treatment the patient remains tumour free. To our knowledge, this is the first case of multiple SCCs treated by ECT in the context of systematized linear porokeratosis. Our case highlights the challenges associated with diagnosing and managing this unusual form of porokeratosis.

A rare case of multiple variants of porokeratosis in the same patient: The clue of dermoscopy for diagnosis and therapeutical update

“…Surgical treatment and cryotherapy are preferred in areas where topical agents are contraindicated or difficult to be applied. If malignant transformation is suspected, a skin biopsy or surgical excision is mandatory (Sommerlad, et al, 2016; Weidner, et al, 2017).…”

“…There are many therapeutic options, ranging from systemic and topical treatment to photo and laser therapies or even surgery, as summarized in Table , but it still lacks consistency in regards to treatment (Sommerlad, et al, 2016; Uusküla, & Erm, 2015). A systematic review on PK treatment was published by Till Weidner et al in 2017 after an analysis of 88 articles (Weidner, Illing, Miguel, & Elsner, 2017).…”

Neoplastic Multifocal Skin Lesions: Biology, Etiology, and Targeted Therapies for Nonmelanoma Skin Cancers

“…This way, the association of electrochemotherapy with immune stimulation is a very hopeful way for complete and long-term cancer eradication. Further understanding is urgently demanded to authenticate the strong therapeutic potential of the previous combinations [126,127,128]. …”

Electrochemotherapy - yet another innovative application

“…In this issue of the BJD , Sommerlad et al . show that a relatively easy and simple treatment modality, electrochemotherapy (ECT), deserves serious consideration when the above‐mentioned challenges arise …”

“…For several of the above‐mentioned reasons, Sommerlad et al . employed ECT to treat multiple SCCs developed in linear porokeratosis not amenable to surgical resection .…”