When Surgery Won't Cut It: Successful Management of Eruptive Squamous Atypia With Combination Medical Therapy

Sara Yumeen; Benjamin J Kahn; Alexandra Leonard; Asghar Shah; Abrar A Qureshi; Elie Saliba

doi:10.7759/cureus.37694

When Surgery Won't Cut It: Successful Management of Eruptive Squamous Atypia With Combination Medical Therapy

Cureus. 2023 Apr 17;15(4):e37694. doi: 10.7759/cureus.37694. eCollection 2023 Apr.

Authors

Sara Yumeen¹, Benjamin J Kahn¹, Alexandra Leonard¹, Asghar Shah², Abrar A Qureshi³, Elie Saliba¹

Affiliations

¹ Dermatology, Warren Alpert Medical School of Brown University, Providence, USA.
² Medicine, Brown University, Rhode Island, USA.
³ Dermatology/Epidemiology, Warren Alpert Medical School of Brown University, Providence, USA.

Abstract

The termeruptive squamous atypia(ESA) is used to describe squamous proliferations that do not present with high-grade histologic features and for which surgical management may exacerbate the condition. Non-surgical management of ESA with radiation, local or systemic chemotherapy, retinoids, or immunotherapy have been reported with variable success. In contrast, combination treatment with retinoids, immunomodulatory or chemotherapeutic agents may result in a more durable response. We report a case of recalcitrant ESA of the lower extremities where complete clinical remission was induced with triple combination medical management with intralesional 5-fluorouracil, field treatment with topical 5-fluorouracil and imiquimod, and oral acitretin. Our case adds to the literature supporting combination medical therapy for challenging cases of ESA.

Keywords: 5-fluorouracil; acitretin; eruptive squamous atypia; intralesional; multiple keratoacanthoma.

Publication types

Case Reports