Korean J Dermatol.  2019 Feb;57(2):89-93.

Development of Squamous Cell Carcinoma from Actinic Keratosis after Ingenol Mebutate Gel Use

• Choi JW
• Suh DW
• Lew BL
• Sim WY

Abstract

Ingenol mebutate gel is a new short-term topical treatment approved in 2012 by the US Food and Drug Administration and its efficacy has been demonstrated in numerous studies. To report a case of invasive squamous cell carcinoma (SCC) developing after application of ingenol mebutate gel for the treatment of actinic keratosis (AK) and to determine the mechanism of progression. An 82-year-old woman presented with several ill-defined erythematous and telangiectatic patches with thick crusts on the face. The biopsy specimens were consistent with AK. We applied 0.015% ingenol mebutate gel for 3 consecutive days. Most of lesions improved clinically, but one lesion increased in size and progressed to a hyperkeratotic ulcerative plaque by the 2-month follow-up. Wide local excision was performed, and the patient was diagnosed with SCC. A prevailing inflammatory response, stimulates the dysplastic epidermal cells of AK, and the lesion may progress to a rapidly growing SCC through the activation of inflammatory modulators, such as IL-1β and metalloproteinases. Clinicians should acknowledge the possibility of progression of AK lesions induced by the pro-inflammatory effects of ingenol mebutate at low concentrations.

Keyword

Ingenol mebutate; Actinic keratosis; Squamous cell carcinoma

MeSH Terms

Actins*
Aged, 80 and over
Biopsy
Carcinoma, Squamous Cell*
Epithelial Cells*
Female
Follow-Up Studies
Humans
Keratosis, Actinic*
Metalloproteases
Ulcer
United States Food and Drug Administration
Actins
Metalloproteases