NMSC II: surgical - medical management
We report the case of an 80 year old female patient with surgical non resectable squamous cell carcinoma of the scalp. Although wide surgical resection of the tumour was performed complete resection cold not been reached. Thus subsequent radiotherapy was initiated. 3 months later the patient developed new subcutaneous tumors near the first resection area and at the border of the radiation field. Histopathology showed a recurrence of the squamous cell carcinoma and the patient underwent dose-intensifying radiotherapy. However, the tumor continued to grow within the irradiated area, and additional radiotherapy and surgery were impossible. Staging procedures including cranial and neck computertomography, ultrasound of abdomen and peripheral lymph nodes and chest X-ray showed no evidence for further metastazation. Thus we decided to initiate treatment with the cetuximab, an antibody blocking the epidermal growth factor receptor (EGFR), since successful treatments of advanced squamous cell carcinomas of the skin with EGRF-blockers were reported and cetuximab is licensed for the treatment of head and neck squamous cell cancers. Cetuximab was given as a monotherapy, starting with 400 mg/m2, followed by 250 mg/m2 weekly. Clinically, the tumor rapidly improved. Histopathologically most of the tumor bearing area cleared after 2 months, only in one area a well differentiated cornifying squamous cell carcinoma (instead of the previously undifferentiated squamous cell carcinoma) was seen. Currently, the patient continues cetuximab monotherapy with a mild follicular skin eruption as only side effect. This case report underlines the usefulness of EGFR blockers in the treatment of advanced squamous cell carcinomas of the skin which encourage a clinical study.