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Unusual presentation of more common disease/injury
CASE REPORT
Management of a cutaneous squamous cell carcinoma overlying an AV fistula
  1. Neel Som Nath1,
  2. Brian F Gilmore2,
  3. Richard K McCann3,
  4. Paul J Mosca4
  1. 1 School of Medicine, Duke University, Durham, North Carolina, USA
  2. 2 Surgery, Duke University Medical Center, Durham, North Carolina, USA
  3. 3 Surgery, Vascular Surgery, Duke University Medical Center, Durham, North Carolina, USA
  4. 4 Surgery, Advanced Oncologic and GI Surgery, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Mr Neel Som Nath, neel.nath{at}duke.edu

Summary

Cutaneous squamous cell carcinoma (cSCC) currently affects over 700 000 patients per year in the USA alone, and its incidence continues to rise in recent years. A known risk factor for cSCC is chronic inflammation; a cSCC that develops at a site of chronic inflammation is known as Marjolin’s ulcer. We present the case of a 76-year-old man with end-stage renal disease requiring chronic haemodialysis who developed an invasive cSCC at the cannulation site of an underlying arteriovenous (AV) fistula. In this instance, treatment with standard surgical excision or Mohs surgery would pose unique risks associated with injury to an otherwise functional AV fistula. Thus, the lesion was treated with electron beam radiation therapy, which offers a similar efficacy to surgery while minimising risk to the fistula. This resulted in a successful oncological outcome with no complications.

  • Dermatology
  • Skin cancer
  • Vascular surgery
  • Surgical oncology
  • Radiotherapy

https://doi.org/10.1136/bcr-2016-218932

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    Footnotes

    • Contributors NSN was responsible for drafting the case report, literature review and chart review. BFG was responsible for literature review, chart review, direct care of the patient and revising the case report. RKM was responsible for advising care of the patient, describing a novel surgical technique in the report and revising the case report. PJM was responsible for conception of the case report, direct care of the patient and revising the case report. All authors have approved this version of this case report.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.