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Squamous cell carcinoma: case report A woman in her 70s developed squamous cell carcinoma during treatment with mycophenolate mofetil for scleroderma. The woman, who had systemic sclerosis and scleroderma, had been receiving mycophenolate mofetil 3000mg daily [route not stated]. Eventually, she presented with a non-healing scaly lesion on the scalp for 6 months. Examination showed tender crusted and soft nodule on the scalp. Biopsy revealed squamous cell carcinoma [duration of treatment to reaction onset not stated]. The woman underwent Mohs micrographic surgery. The tumour was cleared in four stages. The second Mohs layer found tumoural squamous cell carcinoma islands occluding a large-caliber vessel. The defect was partially closed with a purse-string suture, followed by xenograft. The permanent section of the tissue blocks revealed a poorly differentiated squamous cell carcinoma. Then, she underwent radiation therapy, leaving a alopetic and sclerotic patch on the midscalp and vertex. Seventeen months after completing radiation, she presented with a tender, violaceous and soft nodule on the sclap within the radiated area. Biopsy showed recurrence of squamous cell carcinoma. Subsequently, she underwent Mohs micrographic surgery and cleared the tumour in 2 stages. Permanent sections revealed high-risk features to include involvement of perineural invasion and subcutaneous tissue. She did not develop further recurrence but she had a hyperkeratotic, persistent plaque overlying the surgery site. Biopsy revealed actinic and scar keratosis, for which she received 2 courses of calcipotriol [calcipotriene] and fluorouracil, with no response. The area was stable and consistent with radiation and postsurgical change in the setting of systemic sclerosis. Hoverson K, et al. High-risk cutaneous squamous cell carcinoma with intravascular involvement recurs in a patient with systemic sclerosis. JAAD Case Reports 6: 835-837, 803501076 No. 9, Sep 2020. Available from: URL: http://doi.org/10.1016/j.jdcr.2020.07.012

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Reactions 12 Sep 2020 No. 1821