Vulvar and perineal verrucous changes complicating hidradenitis suppurativa after wide excision: a case and literature review.

Journal Article (Review;Journal Article)

Poorly controlled and long-standing hidradenitis suppurativa (HS) increases the risk of squamous cell carcinoma (SCC). We report a 54-year-old woman with an over 20-year history of HS, who had previously undergone wide perineal excision with secondary intention healing and presented with a painful verrucous vulvar plaque and proximal non-healing perineal wound. The patient had four perineal scouting biopsies performed and excisional biopsy with no evidence of high-grade dysplasia or carcinoma on histology. Chromogenic in situ hybridization was negative for HPV 16 and 18 mRNA; the patient's HIV and HSV PCR were also negative. Our patient was treated with interferon alfa-2b with notable clinical improvement. There is currently no standardized stepwise approach to monitoring verrucous lesions in HS patients with significant risk factors for SCC. Our report highlights a vigilant approach to monitoring. If scouting biopsies are negative, complete testing for high risk HPV strains (HPV 16 and 18) is warranted. If negative, we recommend follow up every 6 months with no further biopsies except if overt clinical changes are observed. We also recommend treatment of verrucous changes to decrease risk of possible malignant conversion. Interferon alfa-2b was effective in decreasing the verrucous lesion burden in our patient and may be considered.

Duke Authors

Cited Authors

  • Ward, RA; Udechukwu, NS; Selim, MA; Jaleel, T

Published Date

  • June 2020

Published In

Volume / Issue

  • 26 / 7

Start / End Page

  • 13030/qt3d37n310 -

PubMed ID

  • 32898403

Electronic International Standard Serial Number (EISSN)

  • 1087-2108

International Standard Serial Number (ISSN)

  • 1087-2108

Language

  • eng