Three cases of cutaneous sarcoidosis and squamous cell carcinoma (SCC) in the same patients highlight the need for doctors to be vigilant when sarcoidosis patients develop new, unusual skin lesions, according to a case study.
The research, “Sarcoidosis and squamous cell carcinoma: a connection documented in a case series of 3 patients.” was published in the journal Cutis.
A number of studies linking pulmonary sarcoidosis to increased risk of cancer have been published since the first one in 1974. But few studies have examined the relationship between cutaneous sarcoidosis and malignancy.
Two of the three patients with sarcoidosis who developed SCC of the skin were black, which researchers found surprising because skin cancer is not common among blacks. The finding underscores the potential for SCC to develop in all cutaneous sarcoidosis patients.
One patient was a 60-year-old black women whose sarcoidosis affected her lungs and skin. Doctors were able to control her disease with 40-milligram injections of adalimumab twice a week.
She then developed a painful dark lesion on the middle finger of her right hand whose size began increasing. Doctors diagnosed it as SCC, and removed it with microsurgery.
The second patient was a black woman in her 60s with a history of cutaneous sarcoidosis. She was being treated for the condition — with a different therapy — when a dark lesion began growing on the left side of her lower jaw.
When a biopsy revealed the lesion was SCC, surgeons removed it.
The third patient was a 60-year-old white man with a history of inactive pulmonary sarcoidosis. A series of multiple nonmelanoma skin cancers developed on his scalp, which doctors diagnosed as an invasive SCC. Later, the patient was diagnosed with cutaneous sarcoidosis. Doctors used surgery to remove the SCC and began treating him for sarcoidosis.
Three years later the man developed two new SCC lesions and lesions resembling those in SCC that turned out to be from hyperkeratotic cutaneous sarcoidosis.
Surgeons removed the malignancies. The patient was treated for cutaneous sarcoidosis with corticosteroids applied to the skin and other therapies.
“An association between sarcoidosis and malignancy has been suggested for several decades,” the study’s authors said. “We specifically report 3 cases of patients with cutaneous sarcoidosis who presented with concurrent cutaneous SCCs. Given the varied and often nonspecific nature of cutaneous sarcoidosis, these cases highlight the importance of biopsy when sarcoidosis patients present with new and unusual skin lesions. Additionally, they illustrate the importance of thorough skin examinations in sarcoidosis patients as well as some of the challenges these patients pose for dermatologists.”