10.5826/dpc.1204a136
text/xml
2160-9381
2027
en
Michela Starace
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
subungueal squamous cell carcinoma; squamous cell carcinoma (SCC); HIV infection; photodynamic therapy (PDT); 5-aminolaevulinic acid (5-ALA).
Recurrent microinvasive subungueal squamous cell carcinoma in an HIV patient: a case of good response to photodynamic therapy
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2021-09-12
2022-10-31
2022-11-29
e2022136
Dermatol Pract Concept
Michela Starace
2022/10/31
10.5826/dpc.1204a136
e2022136
Dermatology - IRCCS Policlinico di Sant’Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy. Via G. Massarenti 1, 40138 Bologna, Italy
2160-9381
subungueal squamous cell carcinoma; squamous cell carcinoma (SCC); HIV infection; photodynamic therapy (PDT); 5-aminolaevulinic acid (5-ALA).
en
e2022136
Recurrent microinvasive subungueal squamous cell carcinoma in an HIV patient: a case of good response to photodynamic therapy
https://dpcj.org/index.php/dpc/article/download/2027/1797
     Recurrent Microinvasive Subungueal Squamous
     Cell Carcinoma in a HIV Patient: a Case of Good
           Response to Photodynamic Therapy
        Aurora Alessandrini1,2, Valeria Evangelista1,2, Alessia Barisani1,2, Sabina Vaccari1,2,
                   Emi Dika1,2, Bianca Maria Piraccini1,2, Michela Starace1,2


1 Dermatology - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy



Key words: subungueal squamous cell carcinoma, squamous cell carcinoma, HIV infection, photodynamic therapy, 5-aminolaevulinic acid
Citation: Alessandrini A, Evangelista V, Barisani A, et al. Recurrent microinvasive subungueal squamous cell carcinoma in a HIV patient:
a case of good response to photodynamic therapy. Dermatol Pract Concept. 2022;12(4):e2022136. DOI: https://doi.org/10.5826/
dpc.1204a136
Accepted: February 21, 2022; Published: October 2022
Copyright: ©2022 Alessandrini et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Bianca Maria Piraccini, Dermatology - IRCCS Policlinico di Sant’Orsola - Department of Experimental, Diagnostic
and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy. Via G. Massarenti 1, 40138 Bologna, Italy.
E-mail: biancamaria.piraccini@unibo.it




Introduction                                                                  Due to the patient decision of denying surgery, we
                                                                         ­decided to perform a cycle of 4 sessions of conventional
A 37-year-old male patient with a verrucous lesion affecting             ­photodynamic therapy (C-PDT), using methyl aminolevuli-
the second finger of the left hand, present for about 3 months.          nate (MAL) (METVIX® cream, Galderma Medical Solutions)
Medical history revealed HIV infection, Kaposi sarcoma, anal             ­under occlusion for three hours. The lesion was irradiated by
squamous cell carcinoma (SCC) and muco-cutaneous leish-                  a red light-emitting diode lamp (Aktilite CL128®, Galderma,
maniasis. The diagnosis of microinvasive subungual SCC was               wavelength 630 nm), at 80 mW/cm2 for 12 minutes. The
made with a punch biopsy. The patient denied radical surgery             procedure was repeated 4 times at one-week intervals. After
and a conservative shaving was performed. Eight months                   the first step we observed a partial improvement (Figure 1,
later, the lesion relapsed (Figure1, A and B). The d
                                                   ­ iagnosis of         C and D) After the fourth C-PDT step, the lesion had almost
recurrent subungual SCC was made by p
                                    ­ athology. An X-ray                 completely disappeared (Figure 1, E and F). The patient did
of the finger excluded a bone involvement.                               not relapse 6 months after last C-PDT session.




Image Letter | Dermatol Pract Concept. 2022;12(4):e2022136                                                                                 1
Figure 1. (A) clinical presentation of recurrent subungual squamous cell carcinoma (SCC) on the second finger of the left hand.
(B) ­Dermoscopy of the verrucous lesion, with hyperkeratosis and dotted vessels. (C) Recurrent subungual SCC after the first step of
­conventional photodynamic therapy (C-PDT). (D) Dermoscopy of the lesion after the first step of C-PDT. (E) Recurrent subungual SCC
 after the fourth step of C-PDT. (F) Dermoscopy of the lesion after the fourth step of C-PDT.




2                                                                         Image Letter | Dermatol Pract Concept. 2022;12(4):e2022136
Teaching point                                                   References
PDT is a safe, non-invasive therapy, with good cosmetic          1. Tan B, Sinclair R, Foley P. Photodynamic therapy for subungual
                                                                    Bowen's disease. Australas J Dermatol. 2004;45(3):172-174.
­results, for several dermatologic conditions, such as actinic
                                                                    DOI: 10.1111/j.1440-0960.2004.00082.x. PMID: 15250896.
keratosis and superficial non-melanoma skin cancer [1-2].
                                                                 2. Wu L, Chen W, Su J, et Al. Efficacy of the combination of
We hypothesize that C-PDT may be a promising therapy                ­superficial shaving with photodynamic therapy for recalcitrant
for high-risk recurrence SCC, especially in acral sites, lead-       ­periungual warts. Photodiagnosis Photodyn Ther. 2019;27:340-
ing to a rapid healing process and being at the same time a           344. DOI: 10.1016/j.pdpdt.2019.06.021. PMID: 31252143.
well-tolerated, less painful procedure.




Image Letter | Dermatol Pract Concept. 2022;12(4):e2022136                                                                       3
