Abstract

Patients with chronic lymphocytic leukemia (CLL) are at a significantly increased risk of developing cutaneous squamous cell carcinoma (SCC), in part because of their impaired immunosurveillance. Here, we report the cases of 4 patients with CLL who had locally aggressive cutaneous scc managed with radiotherapy for local recurrence following surgical excision. All tumours were located in the head-and-neck region. All patients initially achieved complete regression of disease; however, 2 had local recurrence a mean of 8 months after treatment completion. One patient died from progressive SCC. Our findings agree with the high rates reported in literature of multiple tumours, local recurrence, metastases, and mortality from scc in patients with cll. Radiotherapy plays an important role in patient management, and it is the recommended treatment modality when complete surgical excision of disease would result in anatomic and functional defects. Radiotherapy is often used in the case of local recurrence after one or more attempts at surgical excision. Dose escalation through intensity-modulated radiotherapy, hyperfractionation, or novel treatment techniques such as high-intensity focused ultrasound may be explored to improve local control of scc lesions. To optimize patient outcomes, cutaneous SCC arising in patients with a history of cll should be managed and followed in a multidisciplinary clinic, with regular skin surveillance and prompt treatment.

Highlights

  • Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in the United States and Western Europe 1

  • We identified 4 patients with a history of CLL who were treated with radiotherapy for a cutaneous squamous cell carcinoma (SCC) after local recurrence following surgical excision from June 2005 to August 2007

  • We describe 4 patients seen in our multidisciplinary non-melanoma skin cancer clinic who had local recurrence following surgical excision of a cutaneous SCC in the head-and-neck region, where further surgery was not recommended, and the treatment modality of choice was local radiotherapy

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Summary

Introduction

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in the United States and Western Europe 1. The multidisciplinary non-melanoma skin cancer clinic at the Odette Cancer Center includes a radiation oncologist, a plastic surgeon, and a dermatopathologist. These practitioners assess patients and jointly render a treatment recommendation. We searched the database to identify patients with a history of CLL who were treated with radiotherapy after local recurrence following surgical excision of a AGGRESSIVE SCC IN CLL PATIENTS cutaneous SCC. Information on treatment-related factors, including SCC location, number of excisions, final surgical pathology, time to recurrence from last surgery, tumour size at the time of radiation, radiation treatment details, and treatment outcomes were recorded. The total number of SCC lesions (including local recurrences) treated with surgery or radiotherapy were documented

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