Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4091-4097
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4091
Hydroxyurea-induced cutaneous squamous cell carcinoma: A case report
Yan Xu, Jian Liu
Yan Xu, Jian Liu, Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Both authors added work and value to the manuscript.
Informed consent statement: Informed consent was obtained from the patient prior to the writing of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Liu, MD, Chief Physician, Surgeon, Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China. liujianzy@zju.edu.cn
Telephone: +86-571-87236878 Fax: +86-571-87236878
Received: September 21, 2019
Peer-review started: September 21, 2019
First decision: October 24, 2019
Revised: November 12, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 6, 2019
Processing time: 75 Days and 20.2 Hours
Abstract
BACKGROUND

Hydroxyurea (HU) is a non-alkylating antineoplastic agent that is active in the S-phase of the cell cycle and inhibits the enzyme ribonucleoside reductase. HU is currently used to treat leukemia, sickle cell anemia, psoriasis, and chronic myeloproliferative disorders. Although HU is easy to use and effective and has high tolerance, there have been numerous reports of cutaneous complications during long-term therapy with HU.

CASE SUMMARY

We report a 67-year-old woman on long-term HU therapy for primary myelofibrosis who developed concurrent skin lesions during treatment. The first skin lesion appeared on the dorsum of her right hand in 2015. Despite continuous use of HU, her cutaneous changes were neglected. Approximately 3 years ago, she had multiple nodular and keratotic lesions on both hands with sharp margins, branny desquamation, and dotted hyperpigmentation. Furthermore, she developed acutely numerous ulcerative lesions on her hands and legs. Topical wound therapy with dressing changes and parenteral antibiotics was applied for management of the lesions. Most of the wounds healed after HU withdrawal. Lesions on both hands were replaced by scabs. Nevertheless, the wound on her left ankle reached 9 cm × 7 cm in size in January 2018. Pathology confirmed well-differentiated squamous cell carcinoma at the ulcer area. In addition, her left foot was severely affected and radical surgery with a below-the-knee amputation was suggested followed by preventive right groin nodal dissection.

CONCLUSION

In patients receiving continuous HU therapy, close dermatologic follow-up is critical for the early diagnosis and selection of appropriate treatment for cutaneous lesions.

Keywords: Hydroxyurea; Squamous cell carcinoma; Primary Myelofibrosis; Case report

Core tip: Long-term hydroxyurea (HU) therapy is a rare cause of cutaneous squamous cell carcinoma (cSCC). To our knowledge, fewer than 20 cases of HU-related cSCC have been reported. Recognizing patterns of HU-associated cSCC is important for surgeons and dermatologists. Moreover, early diagnosis and evaluation are critical for determining optimal treatment regimens. We review the reported cases of cSCC and discuss the pathogenic mechanisms.