Eruptive non-melanoma skin cancers/squamous atypia following skin surgery. Report of two new cases, concise review of the literature with special emphasis on treatment options

Marco Adriano Chessa; Valentino Marino Picciola; Federica Filippi; Annalisa Patrizi; Cosimo Misciali; Bianca Maria Piraccini; Ignazio Stanganelli; Francesco Savoia

doi:10.5826/dpc.1204a193

Eruptive non-melanoma skin cancers/squamous atypia following skin surgery. Report of two new cases, concise review of the literature with special emphasis on treatment options

Authors

Marco Adriano Chessa Dermatology Unit -IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Valentino Marino Picciola University of Bologna, School of Medicine and Surgery, Bologna, Italy.
Federica Filippi IRCCS Azienda Ospedaliero-Universitaria di Bologna; Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
Annalisa Patrizi Dermatology Unit -IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Cosimo Misciali Dermatology Unit -IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Bianca Maria Piraccini Dermatology Unit -IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Ignazio Stanganelli Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
Francesco Savoia Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

Keywords:

Eruptive non-melanoma skin cancers, keratoacanthomas after cutaneous surgery, keratoacanthomas AND split-thickness skin graft, cutaneous squamous cell carcinomas AND split-thickness skin graft, cutaneous squamous cell carcinomas after cutaneous surgery, squamous cell carcinoma after Mohs micrographic surgery.

Abstract

Multiple eruptive cutaneous non-melanoma skin cancers(NMSCs) have been reported to arise at the sites of skin surgery, including the area affected by the primary tumour and split thickness skin graft(STSG) donor and recipient sites. The aim of this study is to make a critical revision of the literature, analysing the clinical, histological features and outcomes of eruptive NMSCs after cutaneous surgery. Up to August 2021, according to our systematic review of the literature, we have collected 18 published articles and a total of 33 patients, including our two 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 82.35% of the cases in the literature; (ii) the median time to onset of eruptive NMSCs that is approximately 6 weeks; (iii) primary NMSCs were completely excised with free margins on histologic examination in all cases of the literature, and therefore the eruptive NMSCs reported could not be considered recurrences; (iv) any surgical technique involves a risk to promote eruptive NMSCs; (v) treatment of eruptive NMSCs includes surgery or combined surgical and medical treatment. However, eruptive NMSCs recurrences are a real medical challenge and have always been treated combining surgical and medical treatment, with complete resolution in about one third of patients. In conclusion, even though the pathogenesis remains unclear, this review highlights 5 red flags which could support clinicians in the diagnosis and management of eruptive of NMSCs after skin surgery.

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