Giant squamous cell carcinoma in HIV-positive patient

CLINICAL IMAGES

Giant squamous cell carcinoma in HIV-positive patient

Cassio Porto Ferreira^I; Heliomar de Azevedo Valle^II; José Alvimar Ferreira^III; Ricardo Barbosa Lima^IV; Carlos José Martins^V

^IMaster - Dermatologist of IPEC/FIOCRUZ

^IIPhD/Professor - Discipline of Pathological Anatomy, Universidade Federal do Estado do Rio de Janeiro (UNIRIO)

^IIISpecialist/Professor - Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO)

^IVSpecialist/Professor - Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO)

^VSpecialist / Professor - Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO)

^{Correspondence}

CLINICAL INFECTIOUS DISEASES IMAGES

Sixty year-old male,white,and HIV seropositive in use of zidovudine, lamivudine and efavirenz, presenting tumor located in scalp, progressing with rapid growth during one year. Upon dermatological examination, it was evidenced extensive tumor of infiltrated and exophytic appearance, covered by necrotic material, and located bilaterally in the parietal region (Figures 1, 2). The histopathological examination revealed a diagnosis of well differentiated squamous cell carcinoma (SCC), (Figures 3, 4). Additional tests were performed, such as CD4: 62 cells/mm³; CD8: 1,654 cells/mm³; viral load: 91,000 copies. CT brain scan revealed cerebral foci of calcification in the suprasellar region and basal ganglia on the left, with about 1.50 cm in diameter and invasion to the skull along the interparietal suture (Figure 5). The patient evolved with pneumonia and subsequent death, it was not possible to investigate visceral metastases. The skin is the most frequently organ affected in HIV seropositive patients, and the prevalence of skin problems during the course of infection may reach 92%.¹ SCC is a malignant skin cancer with an invasive nature, consisting of atypical proliferation of spinous cells that may cause metastases to regional lymph nodes and internal organs, accounting for about 25% of skin cancers.² Immunosuppressed patients have a greater potential for tumor growth, cell differentiation, and aggressiveness that can occur in all HIV infection stages.³ The local recurrence, metastasis, and survival are not related to the number of opportunistic infections or CD4 count and should be treated aggressively, after assessing the degree of immunosuppression and prognosis of HIV infection. Mohs micrographic surgery is the treatment of choice.⁴

Submitted on: 04/27/2009

Approved on: 09/25/2009

We declare no conflict of interest.

*Department of Dermatology, Hospital Universitário Gaffrée e Guinle/Universidade Federal do Estado do Rio de Janeiro (UNIRIO).

• 1. Porro AM. Manifestações dermatológicas da infecção pelo HIV. An Bras Dermatol 2000; 75(6):665-91.
• 2. Marks R. Squamous cell carcinoma. Lancet 1996; 347:735-8.
• 3. Maurer TA. Cutaneous Squamous Cell Carcinoma in Human Immunodeficiency Virus-Infected Patients. Arch Dermatol 1997; 133:577-83.
• 4. Nguyen P. Aggressive Squamous Cell Carcinomas in Persons Infected with the Human Immunodeficiency Virus. Arch Dermatol 2002; 138:758-63.

Publication Dates

• Publication in this collection
  11 June 2010
• Date of issue
  Apr 2010