🔍 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.