Multiple squamous cell carcinomas in a patient with mycosis fungoides

Abstract

A 51-year-old man with type IV skin presented for evaluation of a generalized rash associated with multiple ulcerated, nodular lesions on his legs. The nodular lesions occurred approximately 18 months after the initial onset of generalized rash, which had been diagnosed as plaque/patch stage mycosis fungoides. He continued to develop further nodular lesions on his trunk in the weeks following presentation. The nodular lesions were shown to be squamous-cell carcinoma on histopathology. He had received only topical hydrocortisone prior to the development of the second cutaneous malignancy and had no past exposure to carcinogens. His squamous cell carcinomas were treated with surgical excision and split-skin grafting. He received total skin electron-beam therapy to treat the mycosis fungoides. Second malignancy in mycosis fungoides is a recognized phenomenon and usually occurs after potentially carcinogenic therapy. This case demonstrates the occurrence of second malignancy in the absence of a precipitating factor, suggesting that there are innate, immune-mediated mechanisms in the development of cancer in patients with mycosis fungoides.

Incidence and epidemiology of non‐Hodgkin lymphoma and risk of second malignancy among 22 466 survivors in Israel with 30 years of follow‐up

“…Some published reports have dealt with analysis of the risk of developing other cancers according to the NHL histopathology at diagnosis and indeed in our study it was evident that Jews with T‐NHL had a higher incidence of second malignancy. This observation is in accordance with those reported in other smaller cohorts, with the most frequent being cutaneous T‐cell lymphomas, mostly mycosis fungoides and Sezary syndrome . The occurrence of second malignancies following T‐NHL has generally been attributed to immune‐mediated mechanisms but links to genetic and environmental factors have also been suggested .…”

Cutaneous squamous cell carcinoma arising within a mycosis fungoides patch: Case report and review of the literature

“…SCC development in an active, untreated MF lesion is even rarer. 5,6 Terada 5 reported a case of poorly differentiated SCC cells infiltrating an MF patch on the face of an 86-year-old patient, shortly after the diagnosis of MF. Le et al 6 described multiple, moderately differentiated SCCs in the MFaffected skin of the leg, arm, shoulder, chest, and neck of a 51-year-old male patient within several weeks of CTCL diagnosis.…”

“…5,6 Terada 5 reported a case of poorly differentiated SCC cells infiltrating an MF patch on the face of an 86-year-old patient, shortly after the diagnosis of MF. Le et al 6 described multiple, moderately differentiated SCCs in the MFaffected skin of the leg, arm, shoulder, chest, and neck of a 51-year-old male patient within several weeks of CTCL diagnosis. The three patients whose cases have been reported in the literature, which includes our patient, had low-grade disease at the time of SCC diagnosis without prior carcinogenic MF treatments, suggesting that potential alterations in the early tumor microenvironment predispose patients to the development of secondary SCC.…”

Case report Mycosis fungoides - a case report

“…Second malignancy in MF is a recognized phenomenon and usually occurs after potentially carcinogenic therapy [16]. On the other hand, the unique feature of cutaneous T cell lymphoma is that the malignant T cell clone expands at the expense of normal T cells, creating an immunodeficiency, so patients with cutaneous T cell lymphoma have an increased risk of second malignancies such as multiple squamous cell carcinomas, and can die due to bacterial infections and septicemia or viral infections [6,11,16]. Our case also confirms these results, since our patient was diagnosed with squamous cell carcinoma.…”