Aggressive Cutaneous Squamous Cell Carcinoma (SCC) in Chronic Lymphocytic Leukaemia (CLL).

Aim

The aggressive nature of cutaneous SCC in CLL, specifically presentation with locally invasive, regional metastatic or loco-regionally recurrent disease, is not well documented. We describe a series of patients with CLL who have developed aggressive SCC.

Methods

Patients with CLL with aggressive SCC were identified from existing databases in the Department of Haematology and Oncology, Princess Alexandra Hospital, Australia from August 2001–May 2005. Patient demographics, tumour characteristics and treatment received were reviewed from the clinical records.

Results

We identified 12 patients with CLL with aggressive head and neck SCC: 11 locally invasive, 7 with lymph node metastases and 5 with loco-regional recurrence.

The median age was 73 (range 49–88) and 9 patients were male. 8 patients were Rai stage III or IV. 8 of 9 patients with documented IgG levels had hypogammaglobulinemia (median 3.4g/L). 143 patients with CLL were seen in the hematology department during this time. The median time from CLL diagnosis to SCC development was 55 months (range 0–169). Median time from chemotherapy to aggressive SCC was 48 months (range 22–110) with alkylating agent chemotherapy (seven patients) and 12.5 months (range 1–46) with purine analogue chemotherapy (six patients). Four patients had received no treatment for CLL. All patients had extensive surgical resection and 11 had, or are planned for, post-operative radiotherapy. Five developed loco-regional recurrence at a median of 12 months (range 4–14). 10 patients had numerous SCC (>5) excised prior to the diagnosis of aggressive SCC.

Conclusions

The risk of patients with CLL developing aggressive cutaneous SCC, with its attendent morbidity, is underappreciated. Cellular and humoral immunodeficiencies from CLL and its chemotherapy treatment may predispose patients to aggressive SCC.