Cohen Philip R, Cohen-Kurzrock Rena A, Riahi Ryan R
Department of Dermatology, UC Davis Medical Center, University of California, Davis, Sacramento, California, USA; Touro University California College of Osteopathic Medicine, Vallejo California, USA.
University of Virginia Health, Charlottesville, Virginia, USA.
Clin Dermatol. 2024 Nov-Dec;42(6):585-601. doi: 10.1016/j.clindermatol.2024.09.014. Epub 2024 Sep 10.
Patients with hidradenitis suppurativa (HS) have an increased risk of developing cancer. This includes not only hematologic malignancies and solid tumors but also cutaneous squamous cell carcinoma (SCC) originating within the HS lesions. The development of SCC is most commonly associated with Caucasian men who smoke and have severe gluteal or perianal lesions of more than 25 years. Other factors that have occasionally been associated with HS-related SCC include treatment with a tumor necrosis factor-alpha inhibitor (such as infliximab and adalimumab), genodermatoses (such as keratitis-ichthyosis-deafness syndrome and Dowling-Degos disease), and paraneoplastic syndromes (such as hypercalcemia, hypercalcemia-leukocytosis, and paraneoplastic neuropathy). The tumor may demonstrate the presence of human papillomavirus; even after treatment, patients have a poor prognosis because cancer metastasis, recurrence, or both commonly occur. The potential role of human papillomavirus vaccination for cancer prevention and early treatment of SCC with targeted therapy (with an epidermal growth factor inhibitor such as cetuximab) and/or checkpoint inhibitor immunotherapy (such as cemiplimab and pembrolizumab) remains to be determined. Rarely, HS lesions have mimicked cutaneous metastases in patients with visceral malignancy by demonstrating an increased uptake of fluorine-18 fluorodeoxyglucose on positron emission tomography and/or computed tomography scans. Primary cancers (such as cutaneous SCC and mucinous adenocarcinoma) and breast cancer skin metastases can masquerade as HS lesions. When a lesion is located at a current or earlier site of HS that is new or rapidly growing and/or does not respond to HS-directed therapy, prompt evaluation to establish or exclude the diagnosis of cancer should be considered.
化脓性汗腺炎（HS）患者患癌风险增加。这不仅包括血液系统恶性肿瘤和实体瘤，还包括起源于HS病变内的皮肤鳞状细胞癌（SCC）。SCC的发生最常见于吸烟且患有严重臀或肛周病变超过25年的白种男性。其他偶尔与HS相关SCC有关的因素包括肿瘤坏死因子-α抑制剂治疗（如英夫利昔单抗和阿达木单抗）、遗传性皮肤病（如角膜炎-鱼鳞病-耳聋综合征和道林-迪戈斯病）以及副肿瘤综合征（如高钙血症、高钙血症-白细胞增多症和副肿瘤性神经病变）。肿瘤可能显示有人乳头瘤病毒；即使经过治疗，患者预后也很差，因为癌症转移、复发或两者通常都会发生。人乳头瘤病毒疫苗在癌症预防以及用靶向治疗（如用西妥昔单抗等表皮生长因子抑制剂）和/或检查点抑制剂免疫疗法（如西米普利单抗和帕博利珠单抗）早期治疗SCC方面的潜在作用仍有待确定。很少有情况是，HS病变在正电子发射断层扫描和/或计算机断层扫描上显示氟-18氟脱氧葡萄糖摄取增加，从而在患有内脏恶性肿瘤的患者中模仿皮肤转移。原发性癌症（如皮肤SCC和黏液腺癌）以及乳腺癌皮肤转移可能会伪装成HS病变。当病变位于HS的当前或先前部位，是新出现的、快速生长的和/或对针对HS的治疗无反应时，应考虑及时评估以确定或排除癌症诊断。
