Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer with excellent outcomes after surgical removal in most cases. However, local recurrence occurs in about 4.6% of cases and is a sign of aggressive biologic behavior. Here, we present a case of recurrent SCC with unusual clinical features.
Case Presentation: A 65-year old male with past medical history of untreated prostate cancer and anal cancer status post chemoradiation presented with a nonhealing wound on the right lateral hip. He had previously undergone excision of a squamous cell carcinoma in this area, followed by Mohs surgery due to local recurrence. After both procedures, clear margins were noted histologically. On exam of the right hip there was a large wound with granulation tissue and grouped grey papules and vesicles coalescing into plaques along the posterior edge of the wound which were rapidly progressive. Due to the rapid spread and vesicular nature, infection was initially favored, but the patient did not improve despite treatment with antibiotics and antivirals. The lesion was subsequently biopsied showing moderately differentiated cSCC with high grade features. The patient refused palliative radiation, and cemiplimab, a PD-1 inhibitor, is being initiated.
Discussion: Local recurrence is considered a high-risk feature for cSCC. The threshold for biopsy in cases of possible recurrent cSCC is low, especially given that the clinical presentation can vary, such as the unusual appearance in our case. A multidisciplinary approach is critical in the management of such patients to reduce morbidity and mortality.https://scholarlycommons.henryford.com/merf2020caserpt/1005/thumbnail.jp
