Trial in Progress: A Phase 3 Randomised Study of Low Dose Intralesional Cemiplimab Versus Primary Surgery for Patients with Early-Stage Cutaneous Squamous Cell Carcinoma

Methods: A 74-year-old female with polycythemia vera, treated with ruxolitinib, presented to our clinic.Clinical evaluation revealed multiple hyperkeratotic lesions on her hands and fingers dermoscopically consistent with viral warts and SCCs.Ulcerated plaques, suggestive of basal cell carcinomas (BCCs) and SCCs, were observed on the lower lip, nasal ala, and temporal regions.The patient had a history of nonmelanoma skin cancers (NMSCs) and viral warts, previously treated with cryotherapy, topical imiquimod, and surgeries.Histopathological examinations confirmed SCCs, BCCs with squamous differentiation, and squamous epithelial atypia.Despite ongoing treatments, new keratotic papules and SCCs continued to emerge, particularly on her hands.The patient was referred for treatment of facial lesions, which was performed using electrochemotherapy.Considering the association between ruxolitinib and recurrent NMSCs, a change in therapy was recommended.Acitretin initiation and HPV vaccination were under consideration but have not yet been implemented, as the patient initially received care outside the authors' institution.Results: Although HPV has not yet been confirmed in the patient's lesions, the clinical presentation, including characteristic verrucous lesions, strongly suggests AEV as part of the underlying pathology.Similar cases [2], such as a 67-year-old patient with polycythemia vera treated with ruxolitinib who developed suspected AEV and multiple skin cancers, have been reported in the literature.Conclusions: This case underscores the importance of vigilant dermatologic monitoring and a multidisciplinary approach in patients receiving ruxolitinib.Its immunosuppressive effects may predispose patients to HPV-related conditions and skin malignancies.Advances in HPV typing and gene sequencing may further aid in identifying AEV lesions with a higher risk of progression to SCC.