Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
J Eur Acad Dermatol Venereol. 2022 Jan;36 Suppl 1:63-65. doi: 10.1111/jdv.17406.
Hydroxyurea and ruxolitinib are frequently used to treat myeloproliferative disorders, including polycythaemia vera, and chronic treatment is associated with many cutaneous adverse effects such as the development of aggressive non-melanoma skin cancer (NMSC). We report an 85-year-old man with a history of hydroxyurea- and ruxolitinib-treated polycythaemia vera who was referred for the management of progressively growing tumours on his scalp. Histopathology of the largest scalp lesion revealed a partly desmoplastic cutaneous squamous carcinoma with perineural invasion. Initial imaging revealed metastatic disease in cervical lymph nodes, bones and lungs. The scalp lesions were successfully treated with bleomycin-based electrochemotherapy. Under initial systemic therapy using four cycles of cetuximab, metastatic disease progressed. Following the approval by the health insurance, compassionate use of pembrolizumab monotherapy was initiated. After three cycles of pembrolizumab, however, metastatic disease further progressed and the patient finally died from global respiratory insufficiency. The present case exemplifies the cutaneous adverse effects of long-term hydroxyurea and ruxolitinib therapy, frequently resulting in highly aggressive NMSCs that are usually not responsive to systemic treatments even such as immune checkpoint inhibitors.
羟基脲和芦可替尼常用于治疗骨髓增生性疾病，包括真性红细胞增多症，长期治疗会导致许多皮肤不良反应，如侵袭性非黑色素瘤皮肤癌（NMSC）的发生。我们报告了一例 85 岁男性，有羟基脲和芦可替尼治疗真性红细胞增多症的病史，因头皮上逐渐增大的肿瘤就诊。最大头皮病变的组织病理学检查显示部分硬皮病样皮肤鳞状细胞癌伴神经周围侵犯。最初的影像学检查显示颈部淋巴结、骨骼和肺部有转移性疾病。头皮病变经博来霉素为基础的电化学治疗成功治疗。最初使用 4 个周期的西妥昔单抗进行全身治疗，转移性疾病进展。在获得医疗保险批准后，开始使用帕博利珠单抗单药进行同情治疗。然而，在使用帕博利珠单抗三个周期后，转移性疾病进一步进展，患者最终死于全身呼吸功能衰竭。本例说明了长期羟基脲和芦可替尼治疗的皮肤不良反应，常导致高度侵袭性的 NMSC，即使使用免疫检查点抑制剂等全身治疗，通常也无法控制。
