Three fatal cases of squamous cell carcinoma arising in chronic perineal hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic, inflammatory and suppurative disorder of skin bearing apocrine glands. The most severe complication is squamous cell carcinoma (SCC) and we here present three cases, all of which proved fatal, and review the past 40 years of published cases.

PATIENTS AND METHODS: Three advanced cases of SCC arising in chronic HS have been referred for reconstructive surgery over the past 8 years. Another 28 cases published over the past 40 years were identified using a Medline search (search items in combination: hidradenitis, squamous, carcinoma).

RESULTS: The male:female ratio was 4:1, most (61%) were perineal or buttock. We found no reports of SCC arising in axillary disease. The symptomatic history of HS prior to SCC diagnosis ranged from 3-50 years with a mean of 25 years. Age at diagnosis of SCC ranged from 27-71 years, and 15 patients (48%) died within 2 years of SCC diagnosis.

CONCLUSIONS: We advocate that hidradenitis suppurativa arising in extra-axillary sites is a pre-malignant condition, and should not be treated conservatively; curative resection is the mainstay of management.