Carcinoma epidermoide sobre hidradenitis supurativa: a propósito de un caso

espanolIntroduccion: La hidradenitis supurativa (HS) es una dermatosis inflamatoria cronica que afecta a la unidad pilosebacea en las grandes areas intertriginosas. La inflamacion cronica de larga evolucion favorece el desarrollo del carcinoma de celulas escamosas (CCE) sobre lesiones de HS. Esta complicacion es mas frecuente en varones y en las regiones glutea o perineal. Caso clinico: Varon de 57 anos con HS grave (Hurley III) con >30 anos de evolucion, de predominio en gluteos y resistente a multiples tratamientos; desarrollo un carcinoma epidermoide infiltrante sobre lesiones de HS. Al momento del diagnostico mostraba adenopatias locorregionales de gran tamano. Se descarto el tratamiento quirurgico o radioterapico y se trato con quimioterapia paliativa. Discusion: La infeccion por el virus del papiloma humano (HPV) y otros cofactores parecen intervenir en la transformacion maligna de las lesiones. El retraso diagnostico y una alta capacidad de proyectar metastasis le confieren al carcinoma epidermoide sobre la HS un mal pronostico y elevada mortalidad. Conclusion: Ante una HS avanzada, de larga evolucion y resistente al tratamiento, sobre todo si asienta en la region glutea, se deben tomar multiples biopsias profundas para detectar de manera temprana el desarrollo de un posible carcinoma epidermoide sobre las lesiones. EnglishIntroduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects the folliculosebaceous unit in large intertriginous body areas. Longstanding inflammation might lead to the development of a squamous cell carcinoma arising in HS lesions, which is more likely to occur in males and at the gluteal or perineal sites. Case report: A 57-year-old man with an over 30-year history of severe HS (Hurley III) involving the buttocks and refractory to a wide variety of treatments developed a squamous cell carcinoma over HS lesions. He presented large locoregional lymphadenopathies at diagnosis. Surgery and radiotherapy were dismissed and he was treated with palliative chemotherapy. Discussion: Human papillomavirus (HPV) and other cofactors seem to be involved in the malignant transformation of the lesions. Due to the common delayed diagnosis and its high metastatic ability, prognosis is poor and mortality rates high. Conclusion: Areas of non-healing wounds should be cautiously observed and multiple deep biopsies carried out in patients suffering from longstanding and resistant HS, especially if they involve the buttocks or perineum, in order to detect the development of a squamous cell carcinoma arising in HS lesions at an early stage.