Does Hidradenitis Suppurativa Increase Squamous Cell Carcinoma Risk? A Systematic Review

🔍 Key Finding

Men with long-standing hidradenitis suppurativa (HS), especially Hurley Stage III affecting the perianal/gluteal region, have a significantly increased risk of developing squamous cell carcinoma (SCC). Potential contributing factors include HPV infection and smoking, warranting consideration of HPV vaccination and smoking cessation in this patient population.

🔬 Methodology Overview

Design: Systematic review of literature. Data Sources: PubMed and Medline databases. Search Terms: “hidradenitis suppurativa,” “squamous cell carcinoma,” “HS,” “SCC,” and “acne inversa.” Publication Dates: 1900-2021. Inclusion Criteria: English language original articles, studies on HS patients with SCC, case series, case reports, and randomized controlled trials. Analysis Approach: Analysis of patient demographics, HS characteristics (duration, Hurley stage, location, treatment), and SCC characteristics (age at diagnosis, location, stage, metastasis, treatment, mortality). Focus: Correlation between HS and SCC, risk factors for SCC in HS patients.

📊 Results

Demographics and HS Characteristics: 74 patients with HS and SCC were included; 85.1% (63) were male, and the mean age was 52.67 years. Mean HS duration prior to SCC diagnosis was 25.79 years (range 8-53 years). Most patients (97.2%) were Hurley Stage III. SCC Characteristics: SCCs were most commonly located in the gluteal/perianal region (94.59%), presenting as tumors (61.1%) or ulcers (36.1%). Metastatic status data was unavailable for 62.8% of patients. Among those with data, 37.2% had metastases. SCC Treatment and Outcomes: Surgical excision was the most common treatment (57.4%), followed by radiotherapy (37%). Mortality rate was 40% among the reported cases. Follow-up data varied, but 60% showed no recurrence. Risk Factors: Significant risk factors included male sex, Hurley Stage III, and perianal/gluteal location of HS. Potential risk factors included HPV infection (36% prevalence among tested patients), smoking (24%), diabetes (12%), and Crohn’s disease (12%). Only 5 patients were reported to be using immunosuppressive therapy. HPV Association: HPV was present in 36% of tested patients, with HPV-16 (high-risk) found in 7 out of 8 genital/anal tumors. This suggests a possible role for HPV in SCC development in HS, potentially through autoinoculation facilitated by chronic inflammation and hygiene challenges in affected areas.

💡 Clinical Impact

Squamous cell carcinoma (SCC) is a severe complication of hidradenitis suppurativa (HS), particularly in males with long-standing, Hurley Stage III HS in the perianal/gluteal region. This necessitates increased screening for SCC in all HS patients, especially those with identified risk factors, and suggests surgical intervention may be preferable to conservative dermatological treatment.

🤔 Limitations

Identification of data was very difficult due to the rarity of SCC arising in HS. Most papers were case reports, and authors had different criteria in the assessment of each case. A few authors did not elaborate on the histological details, patient details, and the attempted treatments. The relationship between HS lesions and SCC is yet to be explored and integrated.

✨ What It Means For You

Doctors should screen all hidradenitis suppurativa (HS) patients for squamous cell carcinoma (SCC), especially those with significant risk factors like male sex, long HS duration, Hurley Stage III, and perianal/gluteal lesions. Given the high SCC mortality rate in HS patients, early surgical intervention may be preferable to conservative dermatological treatment.

Reference

Gierek M, Niemiec P, Szyluk K, Ochala-Gierek G, Bergler-Czop B. Hidradenitis suppurativa and squamous cell carcinoma: a systematic review of the literature. Adv Dermatol Allergol. 2023;XL(3):350-354. https://doi.org/10.5114/ada.2023.126563