Cutaneous Squamous Cell Carcinoma and Epidermolysis Bullosa: An Unholy Alliance-Case Report and Review of The Literature

A female patient with a clinical history of Epidermolysis Bullosa (EB) presented with a large, necrotic mass on the posterior aspect of the right leg. The patient had previously undergone a biopsy of the mass at an outside institution that was non-diagnostic for malignancy; the mass had been presumed to be a venous stasis ulcer, and was treated as such. Upon presentation to our clinic, clinical suspicion was that this mass was a wound-derived Squamous Cell Carcinoma (SCC). Repeat biopsy was obtained, with careful consideration to biopsy tumor as opposed to necrotic and granulation tissue within the mass. Pathology confirmed the clinical suspicion and imaging showed that the disease was metastatic. The patient underwent surgery to remove the mass, followed by systemic therapy. This case highlights the phenomenon of skin cancer arising in chronically inflamed or abnormal skin, including scars and/or wounds. This case also elucidates the importance of managing this unique patient population at increased risk of cutaneous malignancy, as well as the salient issues that naturally ensue with obtaining proper diagnosis, including the necessity of repeat biopsy if the initial biopsy results run counter to what clinical suspicion engenders.