Carcinoma of the lip five years after bone marrow transplantation.

A 34-year-old man presented to our observation for a persistent exophytic crust on the right lower lip. Five years before he underwent allogenic bone marrow transplantation for an acute myeloid leukaemia. After transplantation, he developed a severe graft versus host disease with cutaneous and hepatic involvement. He was treated with steroids (stopped by 5 months), mycophenolate mofetil (stopped by 15 months) and photopheresis (stopped by 22 months). Crusty lesions on the lower lip appeared about 6 months before our observation and were treated with antiviral drugs assuming an herpetic infection. An incisional biopsy was performed revealing a squamous cell carcinoma (cT1N0M0). The lesion was surgically excised in general anaesthesia and a vermilion reconstruction with buccal musculomucosal flap combined with V-Y plasty was performed after malignant tumor excision (pT1Nx). Hematopoietic stem cell transplant (HCT) recipients have a well-known substantial risk of developing secondary solid cancers frequently involving the lip and the oral cavity, particularly beyond 5 years after HCT. Several factors as chronic GVHD and prolonged immunosuppressive treatment beyond 24 months are well-documented risk factors for many types of secondary cancers. Conclusion. Screening and preventive care for secondary cancers are pivotal issues among HCT recipients. The frequent involvement of the lip or the oral cavity highlights the importance of ruling out squamous cell carcinoma in presence of persistent lesions in HCT recipients. references • Inamoto Y, Shah NN, Savani BN, et al. Secondary solid cancer screening following hematopoietic cell transplantation. Bone marrow transplantation. 2015. • Atsuta Y, Suzuki R, Yamashita T, et al. Continuing increased risk of oral/esophageal cancer after allogeneic hematopoietic stem cell transplantation in adults in association with chronic graft-versus-host disease. Annals of oncology. 2014;25:435-41. • Rizzo JD, Wingard JR, Tichelli A, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and the American Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASBMT). Bone marrow transplantation. 2006;37:249-61.