Patient with Crohn's disease, 50 years, Infliximab started 10 years ago, skin lesion 2x2 cm on lower limb, surgical resection proves to be a SCC.
Do you think it is a coincidence or is it likely to be iatrogenic?
Do you think I should stop Infliximab since disease is not active?
I think is iatrogenic. If you follow guidelines You should stop immunosupression but it depends of the clinical benefits and alternatives... in psoriasis patients we have more alternatives than in IBD patients.
Some references for you:
http://www.ncbi.nlm.nih.gov/pubmed/?term=24444171
http://www.ncbi.nlm.nih.gov/pubmed/?term=22584081
Some conflicting results, but it may be associated with anti-TNF. Remember, association is not causation, and this may have occurred anyway.
Is this patient taking additional immunosuppressant drugs? Histologically, was SCC undifferentiated, a variety associated more frequently to immunosuppression, or well-differentiated? Was the patient'skin exposed chronically to sun for his work?
We sometimes see SCC in patients treated with TNF-alfa blockers, but our psoriatic patients have been exposed in the past to sun or PUVA therapy or cyclosporin.
In the attached reference you can read about the association, I agree with the previous consideration, association is not causation. Additional co-factors should be considered.
Thank you all for your answers.
In this case, the lesion appeared on the anterior part of the lower limb. There is no particular exposure to sun, no history of psoriasis, NO ADDITIONAL IMMUNOSUPPRESSION.
As for the pathology: It is a well-differentiated invasive SCC, measuring 33 x 35 mm.
I think REMICADE should be stopped especially that the disease (Crohn) is not active for many years, although no direct link can be establised between the treatment and the appearance of the tumor.
We had a UC case, 50yrs famale, who received Inflixmab 5 years ago and was found rectal SCC recently. Her UC has been not active after IFX treatment but not in follow-up. She has no history of skin lesion. Before IFX she received 6-MP but had stopped 5 years ago.
I think canceration is possibly associated with IFX treatment, also I agree association is NOT causation. Mostly we see UC-CRC are adenocarcinoma in pathology. Maybe we should pay more attention on those who received IFX and all kind of immunosuppressors for IBD.
It is reported since rhe beginning of the use of infliximab
Infliximab, a chimeric mouse-human monoclonal antibody, blocks the action of tumor necrosis factor–α and is a highly effective treatment for several inflammatory disorders, including inflammatory bowel disease and rheumatoid arthritis. Although safety data are encouraging, immunosuppressive sequelae may result. We report the acute development of multiple squamous cell carcinomas and keratoacanthomas in a patient receiving infliximab for rheumatoid arthritis.
Journal of the American Academy of Dermatology
Volume 50, Issue 5, Supplement , Pages 75-77, May 2004
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