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Squamous cell cancer (first report for betamethasone) in an elderly patient: case report A 77-year-old man developed squamous cell cancer during treatment with immunosuppressants for plasmacytosis of the lip. The man, who had a 40-pack-year smoking history, had been diagnosed with plasmacytosis 20 years earlier. His condition had been treated with a number of immunosuppressants, including methotrexate, tacrolimus and betamethasone mouthwash [dosage and duration of treatments not stated]. Over a 2-month period, the patient developed an area of induration on the lower lip. A biopsy confirmed invasive well-differentiated squamous cell carcinoma, with a heavy band of chronic inflammation in the submucosa of the primary tumour. Two 1-cm submental nodes were also detected; these were found to be metastatic. The primary tumour site was treated with radiotherapy, and the neck was treated with a comprehensive neck dissection. After 18 months, there was no evidence of local or regional recurrence, and the man’s plasmacytosis had partially resolved. Author comment: "[T]he chronic inflammation resulting from the condition [plasmacytosis] has been well documented as a causative factor in a variety of cancers, the risk of carcinogenesis being proportionate to the duration of inflammation. In addition to the patient’s smoking history, the immunosuppressant therapies he received (especially methotrexate) will have also contributed." Pepper T, et al. Squamous cell carcinoma arising in mucosal plasmacytosis. British Journal of Oral and Maxillofacial Surgery 48: 208-210, No. 3, Apr 2010. Available from: URL: http://dx.doi.org/10.1016/j.bjoms.2009.10.030 - United 803014335 Kingdom

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Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of squamous cell carcinoma [cancer] associated with betamethasone.

0114-9954/10/1302-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

Reactions 22 May 2010 No. 1302