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Aggressive Squamous Cell Carcinomas in Persons Infected With the Human Immunodeficiency Virus
Patricia Nguyen, MD;
Kirsten Vin-Christian, MD;
Michael E. Ming, MD;
Timothy Berger, MD
Arch Dermatol. 2002;138:758-763.
Objectives To illustrate the potential for aggressive growth of cutaneous squamous
cell carcinomas (SCCs) in patients infected with the human immunodeficiency
virus (HIV) and to determine the factors associated with increased morbidity
and mortality from aggressive SCCs in HIV-infected patients.
Design Retrospective nonrandomized case series.
Setting University-based dermatologic referral center.
Patients A consecutive sample of 10 patients infected with HIV who had "aggressive"
SCC based on the following criteria: diameter larger than 1.5 cm, rapid growth
rate, local recurrence, and/or evidence of metastasis.
Main Outcome Measures Morbidity and mortality.
Results Five patients died of metastatic SCC within 7 years of their initial
diagnosis despite treatment. Human immunodeficiency virus stage and the degree
of immunosuppression were not associated with increased morbidity and mortality.
Patients initially undergoing combination surgery and radiation therapy or
radical neck dissection had the best outcomes.
Conclusions Patients infected with HIV can develop rapidly growing cutaneous SCCs
at a young age, with a high risk of local recurrence and metastasis. High-risk
SCCs should be managed aggressively and not palliatively in patients infected
with HIV.
From the Departments of Dermatology, University of California, San
Francisco (Drs Nguyen, Vin-Christian, Ming, and Berger), and University of
Pennsylvania, Philadelphia (Dr Ming); and the Department of Internal Medicine,
New York Presbyterian Hospital (Columbia), New York (Dr Nguyen). Dr Vin-Christian
is now with the Department of Dermatology, Palo Alto Medical Clinic, Palo
Alto, Calif, and the Dermatological Surgical Unit, San Francisco VA Medical
Center.
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