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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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