Title : Increased Skin Cancer development in a previously stable elderly female: A case study
Abstract:
This case report explores the accelerated development of non-melanoma skin cancers (NMSC) in an 83-year-old female with a history of melanoma-in-situ and keratinocyte malignancies. A significant surge in skin cancer frequency occurred over the past year, coinciding with the commencement of Ruxolitinib, a Janus Kinase (JAK) inhibitor prescribed for myelofibrosis.
Eight months prior, suspicious lesions appeared on the patient's nose, left thumb and left foot. The nasal lesion was diagnosed as intraepidermal carcinoma (IEC), while the others were keratoacanthomas. Management involved shave and curettage, and histopathology confirmed the diagnoses. The patient’s six-week review was delayed due to severe anaemia and renal failure. During this time, a recurrent left thumb lesion required urgent excision and grafting by a plastic surgeon, with histopathology revealing infiltrative squamous cell carcinoma.
At six months, the nasal and foot lesions remained clear and had healed satisfactorily. During follow-up, three additional bleeding lesions on the left shoulder, right chest and left thigh were treated with curettage and cautery, with histopathology confirming IEC. The patient, preparing for a long-awaited cruise, prioritised immediate management, and a review was scheduled upon her return.
This case highlights the increased risk of aggressive NMSC associated with immunosuppressive medications like Ruxolitinib, particularly in patients with a history of NMSC or pre-malignant lesions. It highlights the importance of regular skin examinations, optimising medication dosages, sun protection and addressing multiple lesions in single visits for co-morbid patients. A multidisciplinary approach involving dermatologists, oncologists and surgeons is crucial to mitigate risks and ensure optimal patient outcomes.
