Two cases of aggressive squamous cell carcinoma were reported to have developed after the use of newly-approved medications, Ruxolitinib and Belumosudil, for graft-versus-host disease.
Clinical Pearls
Two cases of aggressive squamous cell carcinoma were reported to have developed after the use of newly-approved medications, Ruxolitinib and Belumosudil, for graft-versus-host disease.
As the use of these medications increases, dermatologic providers should be cognizant of potential associations with the development of squamous cell carcinoma.
Discussion:
In this correspondence published within the New England Journal of Medicine, Lee and co-authors describe two cases of aggressive squamous cell carcinoma which developed following the use of two newly approved medications for graft-versus-host-disease. Of note, one of these medications (Ruxolitinib) has been approved for use in a topical form for dermatologic disorders including atopic dermatitis and vitiligo. The authors highlighted both the medications involved may help promote development of aggressive tumors due to their ability to amplify the STAT pathway, promoting regulatory T-cell signaling.
The first case described a patient who presented with cutaneous squamous cell carcinoma after 6 months of treatment with Ruxolitinib. The patient also had a history of three low-stage cutaneous squamous cell carcinomas and was currently being treated with both niacinamide and acitretin to reduce the risk of developing nonmelanoma skin cancer. Of note, his tumor doubled in size in the 3-week period from lesion biopsy to Mohs surgery. Histopathology also showed intravascular invasion at three foci, which the authors cite is often associated with lymph-node metastasis.
The second case described a patient who was treated with Belumosudil for seven months prior to presenting with a squamous cell carcinoma of the mid-scalp which was excised with Mohs surgery and cleared in two stages. Of note, this tumor recurred within 3 months, with surgery halted due to penetration into the calvaria. CT Scan was performed for this patient showing the tumor destroyed the calvaria and invaded the superior sagittal sinus.
留言