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Squamous cell carcinoma of the lip: case report A 28-year-old man developed squamous cell carcinoma of the lip (lSCC) while receiving graft-versus host disease (GVHD) prophylaxis with tacrolimus and prednisone, and antifungal prophylaxis with voriconazole. The man, who had lymphoblastic lymphoma underwent an allogeneic haematopoietic stem cell transplantation (HSCT). He was started on GVHD prophylaxis with tacrolimus and prednisone, and antifungal prophylaxis with voriconazole [dosages and routes not stated]. After 32 months of HSCT, he developed biopsy-proven lichenoid GHVD of the trunk and buccal mucosa, which was treated topically [specific drugs not stated]. After three months, he exhibited a painful, enlarging and ulcerated plaque on the lower lip. He presented, nine months post lesion onset. Examination on presentation revealed 2.5×1.7cm verrucous, sessile plaque on the right lower lateral vermilion lip that extended from the vermilion border to the wet vermilion, with complete sparing of the vestibule and other oral structures. Of note, he did not have any associated lymphadenopathy. The lesion, which was initially speculated to be lSCC, was biopsied for confirmation of the diagnosis. A histology of lip biopsy revealed parakeratosis above acanthosis that was composed of atypical keratinocytes with a pushing border into the lamina propria. However, p16 immunohistochemistry finding was negative. The lesion was staged T2a as per Brigham and Women’s criteria. Therapies with voriconazole, tacrolimus and prednisone were considered to be associated with lSCC [duration of treatment to reaction onset not stated]. The man underwent Mohs micrographic surgery (MMS) in hospital. A post-operative defect (lesion measuring 3.5×1.2cm) was noted, which resolved by second intent without functional or cosmetic impairment. Three months post-procedure, a 0.5cm keratotic papule on the right lower vermilion and a 0.6cm lichenoid macule on the left lower vermilion were noted. A repeat histology revealed markedly thickened mucosa with atypia and premature cornification consistent with hyperplastic actinic cheilitis, extending to the base. At the time of biopsy the lesion was treated due to clinical suspicion for actinic keratosis with electrofulguration to the base. Author comment: "[V]oriconazole and UV irradiation are predisposing factors for lSCC." "[I]mmunosuppressive medications, which constitute a well-known risk factor for SCC." Kibbi N, et al. Squamous Cell Carcinoma of the Lip in a Patient With GraftVersus-Host Disease. Dermatologic Surgery 45: 1002-1005, No. 7, Jul 2019. Available from: URL: http://doi.org/10.1097/DSS.0000000000001706 803433911 USA

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Reactions 16 Nov 2019 No. 1779