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KMID : 0363220190570020089
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Korean Journal of Dermatology
2019 Volume.57 No. 2 p.89 ~ p.93
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Development of Squamous Cell Carcinoma from Actinic Keratosis after Ingenol Mebutate Gel Use
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Choi Joong-Woon
Suh Dong-Woo
Lew Bark-Lynn
Sim Woo-Young
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Abstract
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Ingenol mebutate gel is a new short-term topical treatment approved in 2012 by the US Food and Drug Administration and its efficacy has been demonstrated in numerous studies. To report a case of invasive squamous cell carcinoma (SCC) developing after application of ingenol mebutate gel for the treatment of actinic keratosis (AK) and to determine the mechanism of progression. An 82-year-old woman presented with several ill-defined erythematous and telangiectatic patches with thick crusts on the face. The biopsy specimens were consistent with AK. We applied 0.015% ingenol mebutate gel for 3 consecutive days. Most of lesions improved clinically, but one lesion increased in size and progressed to a hyperkeratotic ulcerative plaque by the 2-month follow-up. Wide local excision was performed, and the patient was diagnosed with SCC. A prevailing inflammatory response, stimulates the dysplastic epidermal cells of AK, and the lesion may progress to a rapidly growing SCC through the activation of inflammatory modulators, such as IL-1β and metalloproteinases. Clinicians should acknowledge the possibility of progression of AK lesions induced by the pro-inflammatory effects of ingenol mebutate at low concentrations.
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KEYWORD
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Ingenol mebutate, Actinic keratosis, Squamous cell carcinoma
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