Chessa Marco Adriano, Picciola Valentino Marino, Filippi Federica, Patrizi Annalisa, Misciali Cosimo, Piraccini Bianca Maria, Stanganelli Ignazio, Savoia Francesco
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Dermatol Pract Concept. 2022 Oct 1;12(4):e2022193. doi: 10.5826/dpc.1204a193. eCollection 2022 Nov.
Eruptive cutaneous squamous cell carcinomas (ESCC), eruptive squamous atypia (ESA) and eruptive keratoacanthomas (EKA) are different terms used to describe the occurrence of multiple cutaneous squamous neoplasms after skin surgery, laser treatment, traumas, such as tattoos, and local or systemic medical treatments. ESCC have been reported to arise at the sites of skin surgery, including the area affected by the primary tumor and split thickness skin graft (STSG) donor and recipient sites.
The aim of this study is to report 2 additional cases of ESCC after skin surgery and make a critical revision of the literature, analyzing the clinical, histological features and outcomes of ESCC after cutaneous surgery.
Up to August 2021, according to our systematic review of the literature, we have collected 19 published articles and a total of 34 patients, including our 2 cases.
The results of this review highlight five red flags that clinicians should consider: (i) lower and upper limbs represent the cutaneous site with the highest risk, representing 83,78% of the cases in the literature; (ii) the median time to onset of ESCC is approximately 6 weeks; (iii) primary cutaneous squamous cell carcinomas were completely excised with free margins on histologic examination in the totality of the cases of the literature, and therefore ESCC should not be considered recurrences; (iv) any surgical technique involves a risk to promote ESCC; (v) treatment of ESCC includes medical treatment, surgery or combined surgical and medical treatment.
This review highlights 5 red flags which could support clinicians in the diagnosis and management of ESCC after skin surgery.
爆发性皮肤鳞状细胞癌（ESCC）、爆发性鳞状异型增生（ESA）和爆发性角化棘皮瘤（EKA）是用于描述皮肤手术、激光治疗、纹身等创伤以及局部或全身药物治疗后出现多发性皮肤鳞状肿瘤的不同术语。据报道，ESCC可发生于皮肤手术部位，包括原发肿瘤累及区域、中厚皮片（STSG）供皮区和受皮区。
本研究旨在报告另外2例皮肤手术后发生ESCC的病例，并对文献进行批判性回顾，分析皮肤手术后ESCC的临床、组织学特征及转归。
截至2021年8月，根据我们对文献的系统回顾，我们收集了19篇已发表文章及总共34例患者，包括我们的2例病例。
本综述结果突出了临床医生应考虑的五个警示信号：（i）下肢和上肢是皮肤风险最高的部位，占文献中病例的83.78%；（ii）ESCC发病的中位时间约为6周；（iii）在文献中的所有病例中，原发性皮肤鳞状细胞癌在组织学检查时均已完全切除且切缘阴性，因此ESCC不应被视为复发；（iv）任何手术技术都有促进ESCC发生的风险；（v）ESCC的治疗包括药物治疗、手术治疗或手术与药物联合治疗。
本综述突出了五个警示信号，可辅助临床医生对皮肤手术后ESCC进行诊断和管理。
