Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer and its incidence has been increasing over the past decades. SCC in-transit metastases are rare and predict a poor prognosis. We present the case of a 69-year-old patient with a right lower leg SCC, surgically excised w...
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| Format: | Article |
| Language: | English |
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Sociedade Portuguesa de Dermatologia e Venereologia
2021-06-01
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| Series: | Revista da Sociedade Portuguesa de Dermatologia e Venereologia |
| Subjects: | |
| Online Access: | https://revista.spdv.com.pt/index.php/spdv/article/view/1305 |
| _version_ | 1818901560828100608 |
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| author | Joana Barbosa Miguel Coelho Ricardo Vieira Victor Farricha |
| author_facet | Joana Barbosa Miguel Coelho Ricardo Vieira Victor Farricha |
| author_sort | Joana Barbosa |
| collection | DOAJ |
| description | Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer and its incidence has been increasing over the past decades. SCC in-transit metastases are rare and predict a poor prognosis. We present the case of a 69-year-old patient with a right lower leg SCC, surgically excised with free margins. One month later, erythematous to violaceous, firm papules begin to erupt on the right lower leg, evolving to ulcerated nodules over a period of weeks. Homolateral inguinal and iliac nodal metastases were documented by percutaneous biopsy of an inguinal palpable lymph node and later documented by positron emission tomography – computed tomography (PET-CT). Given the unresectability of the disease, regional chemotherapy involving isolated limb perfusion (ILP) with melphalan and tumor necrosis factor-alpha (TNFα) was performed in order to avoid amputation. Macroscopic regression ensued, with complete resolution of all visible in-transit metastases 12 weeks after perfusion. However, a fatal outcome was observed 4 months later, due to systemic metastases. ILP is an effective and well-established technique in the treatment of advanced tumors of the extremities. Its main indications are in-transit metastases of malignant melanoma and advanced soft tissue sarcomas. However, studies have shown its effectiveness in other tumors such as locally advanced SCC. Despite the unfortunate outcome, it was possible to avoid amputation of the limb, with complete local disease remission. |
| first_indexed | 2024-12-19T20:21:42Z |
| format | Article |
| id | doaj.art-12fc7d9850fd4f2ba668022837b35d7b |
| institution | Directory Open Access Journal |
| issn | 2182-2395 2182-2409 |
| language | English |
| last_indexed | 2024-12-19T20:21:42Z |
| publishDate | 2021-06-01 |
| publisher | Sociedade Portuguesa de Dermatologia e Venereologia |
| record_format | Article |
| series | Revista da Sociedade Portuguesa de Dermatologia e Venereologia |
| spelling | doaj.art-12fc7d9850fd4f2ba668022837b35d7b2022-12-21T20:06:59ZengSociedade Portuguesa de Dermatologia e VenereologiaRevista da Sociedade Portuguesa de Dermatologia e Venereologia2182-23952182-24092021-06-0179210.29021/spdv.79.2.1305Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell CarcinomaJoana Barbosa0Miguel Coelho1Ricardo Vieira2Victor Farricha3Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, PortugalDermatology and Venereology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, PortugalDermatology and Venereology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, PortugalGeneral Surgery Department, Instituto Português de Oncologia de Lisboa, Lisbon, PortugalSquamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer and its incidence has been increasing over the past decades. SCC in-transit metastases are rare and predict a poor prognosis. We present the case of a 69-year-old patient with a right lower leg SCC, surgically excised with free margins. One month later, erythematous to violaceous, firm papules begin to erupt on the right lower leg, evolving to ulcerated nodules over a period of weeks. Homolateral inguinal and iliac nodal metastases were documented by percutaneous biopsy of an inguinal palpable lymph node and later documented by positron emission tomography – computed tomography (PET-CT). Given the unresectability of the disease, regional chemotherapy involving isolated limb perfusion (ILP) with melphalan and tumor necrosis factor-alpha (TNFα) was performed in order to avoid amputation. Macroscopic regression ensued, with complete resolution of all visible in-transit metastases 12 weeks after perfusion. However, a fatal outcome was observed 4 months later, due to systemic metastases. ILP is an effective and well-established technique in the treatment of advanced tumors of the extremities. Its main indications are in-transit metastases of malignant melanoma and advanced soft tissue sarcomas. However, studies have shown its effectiveness in other tumors such as locally advanced SCC. Despite the unfortunate outcome, it was possible to avoid amputation of the limb, with complete local disease remission.https://revista.spdv.com.pt/index.php/spdv/article/view/1305AmputationCarcinoma, Squamous CellExtremitiesNeoplasm Metastasis |
| spellingShingle | Joana Barbosa Miguel Coelho Ricardo Vieira Victor Farricha Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma Revista da Sociedade Portuguesa de Dermatologia e Venereologia Amputation Carcinoma, Squamous Cell Extremities Neoplasm Metastasis |
| title | Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma |
| title_full | Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma |
| title_fullStr | Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma |
| title_full_unstemmed | Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma |
| title_short | Isolated Limb Perfusion for the Treatment of Unresectable In- Transit Metastases of Cutaneous Squamous Cell Carcinoma |
| title_sort | isolated limb perfusion for the treatment of unresectable in transit metastases of cutaneous squamous cell carcinoma |
| topic | Amputation Carcinoma, Squamous Cell Extremities Neoplasm Metastasis |
| url | https://revista.spdv.com.pt/index.php/spdv/article/view/1305 |
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