Case presentation
In this case we report a 45‑year‑old patient with untreated psoriasis
who referred to dermatology inpatient department due to erythrodermic
psoriasis, through further evaluation several biopsy specimens were
taken from patient and the result of scalp biopsy was reported to be
SCC. Although this type of NMSC is prevalent among under treatment
psoriatic patients, our case had not received any systemic therapy or
phototherapy. The patient was a 45‑year‑old, mental retard male,
referred to the dermatology inpatient department due to erythrodermic
psoriasis. He was a smoker, unemployed and poor hygiene person who did
not follow up his medical condition over the years. Through his
admission, complete history was taken and it revealed that he was
suffering from localized plaque-type psoriasis for 10 years and was only
under treatment of topical corticosteroids including triamcinolone or
clobetasol two or three times per day as well as topical calcitriol and
emollients. The patient had no history of phototherapy or any oral
antipsoriatic agents. Family history of psoriasis, skin cancers and
other related disorders was also negative. Through admission the patient
had low grade fever and malaise. On dermatological examination we found
diffuse erythematous scaly eruptions over his scalp, trunk and bilateral
extremities, involving 90% of the body surface area [Figure 1, 2].
They were associated with moderate to severe pruritus. A 6 x 5 cm
erythematous, firm, proliferative growth, adherent to the underlying
structures was present over the frontal part of his scalp for 2 years.
Furthermore multiple crusted tumoral lesions were existent diffusely on
the scalp [Figure 3]. These lesions were not related to previous
psoriatic plaques. No lymphadenopathy or mucosal involvement were
detected. Nails pitting and onycholysis were seen in hand and toe nails.
Other evaluations including complete blood cell count, electrocardiogram
and brain CT scan were normal. Multiple skin biopsies were taken from
his scalp and trunk, histopathological investigation of scalp specimen
revealed neoplastic proliferation of epithelial cells with pushing
border and surface ulceration in focal area and clear cell changes in
some area. Neoplastic pleomorphism cells had vesiculated nuclei and
marked mitotic figure was also seen. In another pieces tumoral bulk did
not have attachment to epidermis [Figure 4]. IHC staining showed
strongly positive P63, positive EMA and CK and negative Ber-EP4. These
findings were more favor for squamous cell carcinoma with sebaceous
differentiation. Trunk skin lesion biopsy findings were also consistent
with psoriasis [Figure 5]. Eventually the largest tumoral lesion was
removed through Mohs surgery. Other lesions treated with intralesional
injection of interferon alfa-2a 1.5 million units twice a week.