Squamous Cell Carcinoma in a Patient with Chronic Lymphocytic Leukemia

Abstract

CLL is a malignancy that primarily effects the elderly population and markedly increases their risk of developing skin cancers, especially SCC. An intense infiltrate may be present surrounding the tumor. This case report demonstrates one of the potential challenges the Mohs surgeon may face in interpreting histologic frozen section. Immunohistochemistry may be helpful in providing a more definitive answer to this problem.

In-Transit Metastasis From Primary Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients and Nonimmunosuppressed Patients: Clinical Characteristics, Management, and Outcome in a Series of 21 Patients

“…Five of the 6 nontransplant recipients in this series had tumors classified as high‐risk SCC by Rowe et al 2 including large and/or recurrent tumor. One patient in the nontransplant group had a history of CLL which has been associated with aggressive SCC 10–13 …”

A Diagnosis of Chronic Lymphocytic Leukemia Prompted by Cutaneous Lymphocytic Infiltrates Present in Mohs Micrographic Surgery Frozen Sections

“…Frierson et al 4 and Perez‐Reyes and Farhi 5 reported metastatic disease in 33% to 50% of patients with CLL and SCC. Because of the potential for recurrence and metastasis, management of these cutaneous tumors with microscopically controlled margins is recommended 10,11 …”

“…Because of the potential for recurrence and metastasis, management of these cutaneous tumors with microscopically controlled margins is recommended. 10,11 Cutaneous infiltrates of CLL in association with primary cutaneous malignancies have been described.…”

Lymphocytic Infiltrates and Subclinical Epithelial Tumor Extension in Patients With Chronic Leukemia and Solid-Organ Transplantation

“…For surgeons who perform the Mohs operation, dense lymphocytic infiltrates associated with non‐melanoma skin cancers may pose an intraoperative challenge for interpretation of histologic sections because they obscure possible residual tumor. If the infiltrate represents inflammation caused by tumor, then further resection may be indicated, whereas leukemic infiltrates that do not imply tumor would not require further resection 7 . Leukemic infiltrates also complicate the pathologic findings by camouflaging tumor cells or trapping collagen in a manner that disguises tumor islands.…”