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Research Letter

Recurrent microinvasive subungueal squamous cell carcinoma in an HIV patient: a case of good response to photodynamic therapy

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Introduction

A 37-year-old male patient with a verrucous lesion affecting the second finger of the left hand, present for about 3 months. Medical history revealed HIV infection, Kaposi sarcoma, anal squamous cell carcinoma (SCC) and muco-cutaneous leishmaniasis. The diagnosis of microinvasive subungual SCC was made with a punch biopsy. The patient denied radical surgery and a conservative shaving was performed. Eight months later, the lesion relapsed ( Figure1, A and B ). The diagnosis of recurrent subungual SCC was made by pathology. An X-ray of the finger excluded a bone involvement.

Figure 1 .

( A) clinical presentation of recurrent subungual squamous cell carcinoma (SCC) on the second finger of the left hand. ( B) Dermoscopy of the verrucous lesion, with hyperkeratosis and dotted vessels. ( C) Recurrent subungual SCC after the first step of conventional photodynamic therapy (C-PDT). ( D) Dermoscopy of the lesion after the first step of C-PDT. (E) Recurrent subungual SCC after the fourth step of C-PDT. ( F) Dermoscopy of the lesion after the fourth step of C-PDT.

Due to the patient decision of denying surgery, we decided to perform a cycle of 4 sessions of conventional photodynamic therapy (C-PDT), using methyl aminolevulinate (MAL) (METVIX ® cream, Galderma Medical Solutions) under occlusion for three hours. The lesion was irradiated by a red light-emitting diode lamp (Aktilite CL128 ® , Galderma, wavelength 630 nm), at 80 mW/cm 2 for 12 minutes. The procedure was repeated 4 times at one-week intervals. After the first step we observed a partial improvement ( Figure 1, C and D ) After the fourth C-PDT step, the lesion had almost completely disappeared ( Figure 1, E and F ). The patient did not relapse 6 months after last C-PDT session.

Teaching point

PDT is a safe, non-invasive therapy, with good cosmetic results, for several dermatologic conditions, such as actinic keratosis and superficial non-melanoma skin cancer [ 1 2 ] . We hypothesize that C-PDT may be a promising therapy for high-risk recurrence SCC, especially in acral sites, leading to a rapid healing process and being at the same time a well-tolerated, less painful procedure.

References

  1. Photodynamic therapy for subungual Bowen’s disease Tan B, Sinclair R, Foley P. Australas J Dermatol.2004;45(3):172-174. CrossRef PubMed
  2. Efficacy of the combination of superficial shaving with photodynamic therapy for recalcitrant periungual warts Wu L, Chen W, Su J, et al. Photodiagnosis Photodyn Ther.2019;27:340-344. CrossRef PubMed

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