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Innumerable Squamous Cell Carcinomas in Vietnam War Veteran Exposed to Chemical Defoliants.
J Clin Aesthet Dermatol 2019; 12(8):47-50JC

Abstract

Objective.

We present a successful multidisciplinary treatment approach used for a patient with rapidly developing, high-volume, and high-risk squamous cell carcinomas (SCCs), addressing short-term treatment, long-term maintenance, and appropriate preventative strategies in a difficult patient population. Case report. An immunocompetent, 84-year-old, Caucasian man with at least 30 SCCs of the scalp, head, neck, and upper extremities, including a 4-cm SCC on the vertex of the scalp infiltrating to the periosteum, presented to a cutaneous oncology clinic. Initial physical examination revealed nearly confluent, erythematous, hyperkeratotic, crusted papules and plaques on the head, neck, back, arms, and dorsal hands, all of which were clinically obvious SCC. Nonlesional skin displayed widespread epidermal dysplasia. The patient was seen by the clinic's medical oncology and dermatology teams in coordinated dual visits. The invasive scalp lesion was treated by Mohs surgery and radiation, and the large SCC and field cancerization were successfully treated with a combination of topical and intralesional 5-fluorouracil with pulsed oral capecitabine, which resulted in a significant reduction in SCC disease burden.

Conclusion.

Management of patients with overwhelming numbers of SCCs is extremely challenging. Combination topical and/or intralesional 5-fluorouracil and oral capecitabine may be considered as part of the management approach when mechanical destruction and surgery alone are not feasible. Multidisciplinary care coordinated between the surgeon, dermatologic oncologist, medical oncologist, and radiation oncologist is essential for providing comprehensive treatment and deploying preventative strategies in this population at high risk for metastatic SCC formation.

Authors+Show Affiliations

Dr. DeSimone is with Inova Schar Cancer Institute in Fairfax, Virginia, and the Department of Dermatology at Virginia Commonwealth University School of Medicine in Richmond, Virginia. Ms. Beatson is with the George Washington University School of Medicine in Washington, DC; the Department of Dermatology at Alpert Medical School of Brown University in Providence, Rhode Island; and the Center for Dermatoepidemiology-111D at Veterans Affairs Medical Center in Providence, Rhode Island.Dr. DeSimone is with Inova Schar Cancer Institute in Fairfax, Virginia, and the Department of Dermatology at Virginia Commonwealth University School of Medicine in Richmond, Virginia. Ms. Beatson is with the George Washington University School of Medicine in Washington, DC; the Department of Dermatology at Alpert Medical School of Brown University in Providence, Rhode Island; and the Center for Dermatoepidemiology-111D at Veterans Affairs Medical Center in Providence, Rhode Island.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31531172

Citation

Desimone, Jennifer, and Meghan Beatson. "Innumerable Squamous Cell Carcinomas in Vietnam War Veteran Exposed to Chemical Defoliants." The Journal of Clinical and Aesthetic Dermatology, vol. 12, no. 8, 2019, pp. 47-50.
Desimone J, Beatson M. Innumerable Squamous Cell Carcinomas in Vietnam War Veteran Exposed to Chemical Defoliants. J Clin Aesthet Dermatol. 2019;12(8):47-50.
Desimone, J., & Beatson, M. (2019). Innumerable Squamous Cell Carcinomas in Vietnam War Veteran Exposed to Chemical Defoliants. The Journal of Clinical and Aesthetic Dermatology, 12(8), pp. 47-50.
Desimone J, Beatson M. Innumerable Squamous Cell Carcinomas in Vietnam War Veteran Exposed to Chemical Defoliants. J Clin Aesthet Dermatol. 2019;12(8):47-50. PubMed PMID: 31531172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Innumerable Squamous Cell Carcinomas in Vietnam War Veteran Exposed to Chemical Defoliants. AU - Desimone,Jennifer, AU - Beatson,Meghan, Y1 - 2019/08/01/ PY - 2019/9/19/entrez PY - 2019/9/19/pubmed PY - 2019/9/19/medline KW - Carcinogens KW - nonmelanoma skin cancer KW - squamous cell carcinoma SP - 47 EP - 50 JF - The Journal of clinical and aesthetic dermatology JO - J Clin Aesthet Dermatol VL - 12 IS - 8 N2 - Objective. We present a successful multidisciplinary treatment approach used for a patient with rapidly developing, high-volume, and high-risk squamous cell carcinomas (SCCs), addressing short-term treatment, long-term maintenance, and appropriate preventative strategies in a difficult patient population. Case report. An immunocompetent, 84-year-old, Caucasian man with at least 30 SCCs of the scalp, head, neck, and upper extremities, including a 4-cm SCC on the vertex of the scalp infiltrating to the periosteum, presented to a cutaneous oncology clinic. Initial physical examination revealed nearly confluent, erythematous, hyperkeratotic, crusted papules and plaques on the head, neck, back, arms, and dorsal hands, all of which were clinically obvious SCC. Nonlesional skin displayed widespread epidermal dysplasia. The patient was seen by the clinic's medical oncology and dermatology teams in coordinated dual visits. The invasive scalp lesion was treated by Mohs surgery and radiation, and the large SCC and field cancerization were successfully treated with a combination of topical and intralesional 5-fluorouracil with pulsed oral capecitabine, which resulted in a significant reduction in SCC disease burden. Conclusion. Management of patients with overwhelming numbers of SCCs is extremely challenging. Combination topical and/or intralesional 5-fluorouracil and oral capecitabine may be considered as part of the management approach when mechanical destruction and surgery alone are not feasible. Multidisciplinary care coordinated between the surgeon, dermatologic oncologist, medical oncologist, and radiation oncologist is essential for providing comprehensive treatment and deploying preventative strategies in this population at high risk for metastatic SCC formation. SN - 1941-2789 UR - https://www.unboundmedicine.com/medline/citation/31531172/Innumerable_Squamous_Cell_Carcinomas_in_Vietnam_War_Veteran_Exposed_to_Chemical_Defoliants L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31531172/ DB - PRIME DP - Unbound Medicine ER -