[Metastatic squamous cell carcinoma on an ulcer in graft-versus-host disease after allogeneic stem cell...

We report the case of a 48-year-old multimorbid man who received allogeneic bone marrow transplantation 26 years ago for chronic myeloid leukemia. For 24 years, the patient suffered from sclerodermiform chronic graft-versus-host disease (GVHD) of the skin and lung with partial lung resection and immunosuppressive therapy. Recurrent ulcerations developed on the lower legs at the sites affected by cutaneous GVHD. The patient presented to our clinic with an ulcer progressive in size with resistance to previous therapy. Histologically, squamous cell carcinoma was found. Magnetic resonance imaging showed bone involvement and cutaneous in-transit metastasis, and computed tomography revealed a metastasis in the sacrum. Before therapy was initiated, the patient died suddenly as a result of his previous illnesses. The development of cutaneous GVHD is common in patients with allogeneic stem cell transplantation. The risk for the development of squamous cell carcinoma is increased. Patients should be under close dermatologic surveillance. If squamous cell carcinoma is suspected in pre-existing GVHD, biopsy should be performed promptly to reduce the risk of metastasis.