Ann Dermatol.  2019 Apr;31(2):204-208. 10.5021/ad.2019.31.2.204.

Rapidly Growing and Aggressive Cutaneous Squamous Cell Carcinomas in a Patient Treated with Ruxolitinib

• March-Rodriguez A
• Bellosillo B
• Álvarez-Larrán A
• Besses C
• Pujol RM
• Toll A

• KMID: 2439067
• DOI: http://doi.org/10.5021/ad.2019.31.2.204

Abstract

Ruxolitinib is a Janus kinase (JAK)1 and JAK2 inhibitor approved for the treatment of myelofibrosis and for polycythemia patients who are resistant or intolerant to hydroxyurea. We report a 72 year-old man patient with polycythemia vera who developed multiple cutaneous squamous cell carcinomas (cSCCs) with keratoacanthoma-like histological features while on treatment with ruxolitinib. Similar lesions have been reported in an isolated patient who also received ruxolitinib. Our case confirms that ruxolitinib may induce eruptive cSCCs with characteristic clinical and histological features that differentiate them from conventional non-drug induced lesions. Moreover, we performed a mutational panel analysis of the tumors. The lack of specific mutations in these tumors suggests an impairment of immunosurveillance in the origin of the cutaneous lesions. Frequent and thorough dermatological examinations in patients receiving ruxolitinib with a history of photodamage, skin cancer and/or previous hydroxyurea intake is thus recommended.

Keyword

Carcinoma; squamous cell; Janus kinase 1; Janus kinase 2; Keratoacanthoma; Polycythemia vera

MeSH Terms

Carcinoma, Squamous Cell*
Epithelial Cells*
Humans
Hydroxyurea
Janus Kinase 1
Janus Kinase 2
Keratoacanthoma
Monitoring, Immunologic
Phosphotransferases
Polycythemia
Polycythemia Vera
Primary Myelofibrosis
Skin Neoplasms
Hydroxyurea
Janus Kinase 1
Janus Kinase 2
Phosphotransferases

Figure

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  Fig. 1 Rapidly growing crateriform tumors on the pretibial area (A), presternal (B) and parietal (C).

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  Fig. 2 Proliferating keratin-filled invagination of the epidermis with areas of deep penetrating strands (H&E, ×10).

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  Fig. 3 Small nests of keratinizing cells surrounded by a fibromyxoid and keloid-like stroma at the deep invasion front (H&E, ×40).

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