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Prognosis of an Aquamous Cell Carcinoma in Atopic Dermatis
Mittelviefhaus H.,
Albert-Ludwigs-Universität Freiburg, Augenklinik (Freiburg)
Purpose: Squamous cell carcinoma has a rather good prognosis in immunocompetent patients. However the clinical course is worse in atopic dermatitis. This is a new finding which has to be considered in our treatment strategy.
Patients: 6 patients with severe atopic dermatitis were treated for squamous cell carcinoma of the lids (n=3) or for conjunctival squamous cell carcinoma extending onto the tarsal conjunctiva (age 28-72 years, m=46 years).
Clinical course: 2 patients primarily presented with regional lymph node involvement proven by sonography or biopsy. Further 3 patients developed metastasis 5 to 10 months after tumor excission and 2 of these patients up to 10 years later had a second squamous cell carcinoma on the fellow eye. In 4 patients a neck-dissection and/or a radical parotidectomy were performed. 3 patients had radiotherapy (60 Gy). 2 of the 6 patients died within 11 and 18 months.
Results: Due to the rapid growth the differentiation from keratoacanthoma was difficult. Furthermore, the young age of the patients, the bilateral involvement, the rather high incidence of regional lymph node metastasis, and the agressive tumor growth were unusual. In 3 patients the tumor was associated with a human papilloma virus infection.
Conclusions: Patients with severe atopic dermatitis are in danger do develop multiple rapidly growing squamous cell carcinoma of the lids which may develop early metastasis. Careful sonographic examination for regional lymphadenopathy has to be performed before pretreatment biopsy. Otherwise postoperative inflammatory reaction may mask regional lymph node metastasis. The difficult differentiation between a squamous cell carcinoma and a keratoakanthoma requires histological sections through the entire tumor and in addition knowledges of the clinical appearance and course. Following treatment, carefull follow-up is mandatory. The regional lymph node areas should sonographically be examined every 3 months for the first 2 years and every 6 months thereafter.