Is there any benefit in irradiating a skin tumor that has necrosed after cetuximab and shows a solution of continuity with the subcutaneous cellular tissue, although it is still present (partial response) and it is associated with local lymphadenopathies? Will the wound ever heal?
It depends from the histopathology of the tumor. If the tumor is still present, there will be no healing because of the tumor itself (cancer is like a wound that never heals, goes the definition of the 19th century). If the tumor is present and it is highly malignant, then you should irradiate it. But to answer your question with some scientific accuracy we should know the exact nature of the skin tumor.
It is a grade 1 squamous cell carcinoma, initially with >5 cm, exophytic, suprapubic. Currently, it is an ulcer that occupies about 3/4 of the entire circumference of the scrotum. The tumor still persists, with inguinal lymphadenopathy.
If you suspect and have pathological confirmation that this is malignant the tumor and the regional lymphnodes should be addressed after the patient is properly worked up with a CT and PET to determine the extent of the metastasis. If it is metastatic additional carboplatin based chemotherapy may be warranted
There are publications that intratumoral injections of tetracyclines in skin tumors (metastatic tumors) may be helpful.
The patient is obviously having a T3/4 N2/3 tumour. Prognosis is poor. He will need chemoradiotherapy. Surgery may also have to be considred before or after chemoradiation depending on the practice of the Oncologists in your area and the age and general condition of the patient
Narayanan
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