I am trying to manage a patient with epidermodysplasia verruciformis. He is 26 years old and was treated by repeated surgical excision of the innumerous epidermoid carcinomas on his head and neck region in the last 15 years. Some defective areas which were covered by skin grafts after cancer excision were also developed new epidermoid cancers. He has still multiple skin cancers in variable size and depth on his sun-exposed areas. I am uncertain about his future treatment now.
Hi Irfan,
Please take a look at this review
"We also report a case successfully treated using a combination of photodynamic therapy and oral retinoids"
Dermatol Surg. 2013 Jul;39(7):974-80. doi: 10.1111/dsu.12135. Epub 2013 Feb 25.
Acquired epidermodysplasia verruciformis: a comprehensive review and a proposal for treatment.
This study although old seems interesting too
"We describe here the clinical and laboratory responses to DLE therapy of 2 patients with epidermodysplasia verruciformis (EV), a chronic cutaneous infection with a variety of human papilloma viruses. One patient with longstanding (30 yr) disease and no improvement to therapy showed gradual yet definite resolution of extensive verrucae planae, plaque, tinea-versicolor-like, and tumor lesions scattered over his entire integument
J Clin Lab Immunol. 1984 May;14(1):49-57.
Epidermodysplasia verruciformis: response to therapy with dialyzable leukocyte extract (transfer factor) derived from household contacts.
Vasily DB, Miller OF, Fudenberg HH, Goust JM, Wilson GB.
Good luck!
Rolando, thank you for your contribution. Unfortunately my case is different from the literature as his lesions are all malignant nature. You can clearly realize what I mean after see the attached picture of the patient. I also presented this case previously as a case report which can be found usin this link: https://www.researchgate.net/publication/7597865_An_epidermoid_carcinoma_case_developed_on_old_surgical_scar_in_an_epidermodysplasia_verruciformis_patient?ev=prf_pub
Sincerely.
Article An epidermoid carcinoma case developed on old surgical scar ...
Irfan, I have not seen a so severe case of ED as yours and my idea was to propose systemic retinoids that I have used sucessfully in 4 cases. Low prolonged doses (years) are able to avoid the development of new malignancies. However after I have seen the pictures of your case this does not seem effective for him now..Personally I presume that his malignant lesions must be treated independently each one. Systemic retinoid probably could avoid the development of new ones. Your case clinically look as Xeroderma pigmentosum severe cases that I have seen. I regret no being able to offer a better solution.
Jose, Thank you very much for your contribution. You are right that the case looks as a severe Xeroderma pigmentosum case. I excised and reconstructed at least around 20 malignant lesions of the case, the last one was only a week ago.
Therefore, Irfan , I belive it is time to start with isotretinoin at low dose (10 mg day approx. forban adult depending weigh, general conditions as well as blood tests, to avoid or at least decrease frequency of new malignant epithelil tumors. At these low doses usually there are not important side effects and could be In my exoerence very useful.
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