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A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula

Patients receiving hemodialysis have an increased risk of developing nonmelanoma skin cancers, such as cutaneous squamous cell carcinoma (SCC). Management of SCC usually relies on complete surgical excision of the primary tumor and may require regional lymph node dissection due to lymphatic spread....

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Autores principales: Nyeko-Lacek, Miriam, John, Hannah, Leong, Samantha, Short, Emma, Elazzabi, Tawfik, Jessop, Zita, Hemington-Gorse, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884526/
https://www.ncbi.nlm.nih.gov/pubmed/35242488
http://dx.doi.org/10.1097/GOX.0000000000004100
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author Nyeko-Lacek, Miriam
John, Hannah
Leong, Samantha
Short, Emma
Elazzabi, Tawfik
Jessop, Zita
Hemington-Gorse, Sarah
author_facet Nyeko-Lacek, Miriam
John, Hannah
Leong, Samantha
Short, Emma
Elazzabi, Tawfik
Jessop, Zita
Hemington-Gorse, Sarah
author_sort Nyeko-Lacek, Miriam
collection PubMed
description Patients receiving hemodialysis have an increased risk of developing nonmelanoma skin cancers, such as cutaneous squamous cell carcinoma (SCC). Management of SCC usually relies on complete surgical excision of the primary tumor and may require regional lymph node dissection due to lymphatic spread. An 81-year-old man with an arteriovenous fistula (AVF) presented with an unusually aggressive metastatic well-differentiated SCC, necessitating an axillary dissection for lymph node metastasis. He had been referred for radiotherapy to complete his oncological treatment following excision of the primary SCC on his forearm. An AVF site is subjected to significant changes in circulatory pressure, leading to reduced lymphatic drainage and likely focal immunosuppression. Increased lymphatic burden, combined with repeated trauma to the fistula in an immunosuppressed patient, potentially precipitated the development of an SCC on the affected limb. The individual risk factors for SCC such as sites of chronic inflammation and repeated trauma, host immunosuppression, and renal disease are well established. This patient demonstrates the perfect storm of all these risk factors, leading to a highly malignant metastatic SCC. As the standards of renal care improve and the number of patients with AVF increases, we must remain vigilant in the management of SCCs in these patients.
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spelling pubmed-88845262022-03-02 A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula Nyeko-Lacek, Miriam John, Hannah Leong, Samantha Short, Emma Elazzabi, Tawfik Jessop, Zita Hemington-Gorse, Sarah Plast Reconstr Surg Glob Open Reconstructive Patients receiving hemodialysis have an increased risk of developing nonmelanoma skin cancers, such as cutaneous squamous cell carcinoma (SCC). Management of SCC usually relies on complete surgical excision of the primary tumor and may require regional lymph node dissection due to lymphatic spread. An 81-year-old man with an arteriovenous fistula (AVF) presented with an unusually aggressive metastatic well-differentiated SCC, necessitating an axillary dissection for lymph node metastasis. He had been referred for radiotherapy to complete his oncological treatment following excision of the primary SCC on his forearm. An AVF site is subjected to significant changes in circulatory pressure, leading to reduced lymphatic drainage and likely focal immunosuppression. Increased lymphatic burden, combined with repeated trauma to the fistula in an immunosuppressed patient, potentially precipitated the development of an SCC on the affected limb. The individual risk factors for SCC such as sites of chronic inflammation and repeated trauma, host immunosuppression, and renal disease are well established. This patient demonstrates the perfect storm of all these risk factors, leading to a highly malignant metastatic SCC. As the standards of renal care improve and the number of patients with AVF increases, we must remain vigilant in the management of SCCs in these patients. Lippincott Williams & Wilkins 2022-02-28 /pmc/articles/PMC8884526/ /pubmed/35242488 http://dx.doi.org/10.1097/GOX.0000000000004100 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Nyeko-Lacek, Miriam
John, Hannah
Leong, Samantha
Short, Emma
Elazzabi, Tawfik
Jessop, Zita
Hemington-Gorse, Sarah
A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula
title A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula
title_full A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula
title_fullStr A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula
title_full_unstemmed A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula
title_short A Metastatic Well-differentiated Squamous Cell Carcinoma in a Patient with an Arteriovenous Fistula
title_sort metastatic well-differentiated squamous cell carcinoma in a patient with an arteriovenous fistula
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884526/
https://www.ncbi.nlm.nih.gov/pubmed/35242488
http://dx.doi.org/10.1097/GOX.0000000000004100
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