Aggressive behavior of squamous cell carcinoma in a patient with preceding lymphocytic lymphoma

Cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia

Patients with chronic lymphocytic leukemia are at heightened risk for the development of cutaneous malignancies, especially squamous cell carcinoma. These tumors portend a worse prognosis than is typically seen in immunocompetent patients. Patients with chronic lymphocytic leukemia who develop squamous cell carcinoma are more likely to develop multiple tumors, recurrences after treatment, and regional or distant spread of their tumor. Evaluation of the literature substantiates the ominous nature of squamous cell carcinoma in patients with underlying lymphocytic malignancies.

Highly aggressive squamous cell carcinoma in an HIV-infected patient

Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.

An aggressive spindle cell squamous carcinoma arising in a patient with long-standing erythroderma

Spindle cell squamous carcinoma (SCSC) of the left hand arising in a patient with long-standing erythroderma is reported. Histopathologically, spindle shaped atypical cells were observed neighboring the cells of well differentiated squamous cell carcinoma. These two types of tumor cells, spindle cells and well differentiated cells, were present side by side and merged into each other. The erythroderma had been present for over 20 years, and both clinical and histopathological findings suggested cutaneous T cell lymphoma, but were not diagnostic for mycosis fungoides, Sézary syndrome, or adult T cell lymphoma. Flow cytometry of peripheral blood cells showed a low CD4/CD8 ratio which suggested impaired T cell function. Multiple metastases of SCSC occurred in a short period and the patient died ten months after his first visit to us. The aggressive course of this case was unusual, and may be due to immunological abnormalities associated with the long standing erythroderma with impaired T cell function.

Squamous cell carcinoma of head and neck in patients with well-differentiated lymphocytic lymphoma

Seventy-six cases of well-differentiated lymphocytic lymphoma (WDLL) were reviewed for evidence of additional malignancies. Of these, 18 patients (24%) had one to three further tumors; one half (nine) had squamous cell carcinoma (SCC). The head and neck area was the primary site in all but one case of SCC. The carcinomas were frequently multiple, recurrent, and clinically aggressive. The tumors showed unusually poor differentiation histologically. Actinic keratosis and basal cell carcinomas were frequently associated with SCC. Fifty percent metastasized to cervical lymph nodes replaced by WDLL. Lymphadenopathy due to metastatic SCC may be mistaken for malignant lymphoma alone. In two of five patients (40%), death was directly attributable to SCC. As in renal transplant recipients, SCC of the head and neck in WDLL patients is a common cause of significant complications and mortality requiring aggressive management. Immunosuppression due to WDLL and/or to chemotherapy is likely an important predisposing factor in combination with sun exposure.

Aggressive squamous cell carcinoma of the skin after chronic lymphocytic leukemia

We report two cases of squamous cell carcinoma (SCC) of the skin subsequent to chronic lymphocytic leukemia (CLL). Both cases had an unusually aggressive course for a nonmelanoma skin malignancy with extensive metastases in both, resulting in death in one patient. A literature review supports the likelihood of an increased incidence of SCC in patients with CLL. Though the mechanism is unknown, immunosuppression may play a central role. We urge patients with CLL to avoid exposure to direct sun. Any questionable skin lesion should be biopsied early, and completely excised if it is a tumor. The patient should also be examined thoroughly for metastatic disease via subsequent follow-up visits.

Cutaneous malignancies and metastatic squamous cell carcinoma following topical therapies for mycosis fungoides

Specific treatments for mycosis fungoides, including electron beam irradiation, topical mechlorethamine, and psoralen plus ultraviolet A (PUVA) may be associated with the development of skin cancers after a variable latency period. Because these treatments are often not curative, topical therapies for mycosis fungoides, administered sequentially or concomitantly, are being used increasingly in order to control recurrent disease. This report documents the development of multiple cutaneous tumors, including squamous cell carcinoma, basal cell carcinoma, actinic keratoses, keratoacanthomas, and one case of lentigo maligna, in seven patients who received topical therapies for mycosis fungoides. In contrast to the usual latency period between ionizing radiation therapy and the development of skin cancer, two of our patients who had received prior PUVA therapy developed multiple skin tumors upon completion of electron beam irradiation. The development of metastatic squamous cell carcinoma in two of the other seven patients with multiple cutaneous neoplasms suggests that this potential hazard must be considered in the evaluation and treatment of patients with mycosis fungoides.