Squamous Cell Carcinoma Arising in Hidradenitis Suppurativa -A Case Report

Background: Hidradenitis suppurativa (HS) is a relatively common chronic inflammatory condition affecting apocrine gland-bearing skin. Follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring characterize the disease. Malignant change rarely occurs, and squamous cell carcinoma (SCC) is the most common type. Failure to recognize the condition may lead to poor results. Aim and Objective: The purpose of this study is to highlight the poor prognosis of SCC arising from HS, and raise awareness of the potential for malignant transformation of chronic HS. Case presentation: A 32-year-old man with a 12-year history of biopsy-proven HS of the bilateral buttocks noted that the lesion had enlarged rapidly in 2 months. The patient went to a local hospital and granuloma with wound infection was diagnosed. He received antibiotic treatment but there was no improvement. The patient was then transferred to our hospital. Initial incisional biopsy showed acute and chronic inflammation with acanthosis and hyperkeratosis, but excisional biopsy confirmed SCC. Wide excision was performed with a safe margin of 3 cm. Six weeks after his initial presentation, the patient was diagnosed with left inguinal metastatic lymphadenopathy. He then underwent left inguinal radical lymph node dissection. The patient complained about severe progressive left lower leg pain and numbness after the surgery, and metastatic lymphadenopathy in the left gluteal region near the sciatic notch was diagnosed later. He received post-operative radiotherapy for the gluteal lesion and is now under regular follow-up. Conclusion: Several cases of SCC arising from chronic HS have been reported, and death rates are high. Early recognition and appropriate management should be the goals of both patients and physicians. Metastatic lymphadenopathy should be considered once the disease is diagnosed.