engleski

A case of HPV-induced perianal squamous cell carcinoma

Introduction: Cutaneous squamous cell carcinoma (cSCC) mostly affects areas of photodamaged skin, although it can also develop on areas not previously exposed to sunlight, as well in skin affected with chronic inflammatory processes. Additional risk factors for the development of cSCC include the long-term use of immunosuppressive agents and HPV infection. Case report: A 64-year-old female with fair skin and significant actinic damage, with a history of three melanomas, psoriasis and psoriatic arthritis treated with methotrexate throughout the last 2 years, presented with a newly noticed verrucous lesion in the lowermost part of intergluteal cleft. Physical examination revealed a slightly pink, soft papule of 3-4 mm width, clinically resembling an irritated soft fibroma or intradermal nevus. The lesion was removed by tangential shave biopsy. Histopathological examination revealed a polypoid tumor diagnosed as keratoacanthotic squamous cell carcinoma excised completely and PCR analysis confirmed the presence of HPV 18. In the further course, reexamination of the biopsy site revealed no recurrence of the tumor or presence of any HPV-related lesions, but adjuvant treatment with imiquimod is being considered. In the further workup, gynecological examination and PAP smear test came negative for atypia and HPV, while anal cytological smear revealed atypical cells of undetermined significance (ASCUS) with positive detection of high-risk HPV. Considering the findings, further workup with anoscopy examination is planned. Discussion and conclusion: A recent large case-cohort study found that patients seropositive for HPV 16 and 18 had an increased risk of developing anal and perianal skin cancer. However, our patient also has most of all other well-known risk factors for the development of non-melanoma skin cancer, including a history of immunosuppressive therapy. Therefore, it is hard to say which factor played the most important part in such a rapid development of cSCC in perianal region. We can conclude that management of such patients is challenging and warrants increased vigilance. In addition, any new solitary skin lesion, especially in the perianal area, should be removed with histopathological analysis regardless of whether it appears benign.

Cutaneous squamous cell carcinoma ; Human papilloma viruses ; Genital diseases

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