Development of squamous cell carcinoma in chronic perineal sinus and wounds in Crohn's disease

Two patients with Crohn's disease who developed squamous cell carcinoma in chronic sinus tracts are reported. Because nonhealing perineal sinus tracts or fistulas are relatively common in patients with Crohn's disease, the diagnosis of carcinoma may not be considered until the malignancy is advanced. Because of the potential for a surgical and oncologic "cure," early diagnosis may improve the prognosis. Malignancy should be considered in patients with nonhealing perineal sinuses who develop severe continuous perianal pain. Diagnosis is best made by needle aspiration cytology and sinus tract biopsy. Treatment should include wide excision of the sinus tract, surrounding soft tissue, and lymph nodes, followed by chemotherapy and radiotherapy in selected cases.