HPI: The patient is a 69 yo man with a greater than 40 year history of severe psoriasis. He was a research subject at a prestigious university hospital for many years. Over that time, he has received PUVA, methotrexate and an investigational drug, Rapamycin. He has been treated with NB UVB and acitretin with some improvement. As a result of his therapies, he has developed numerous squamous cell carcinomas. These pose therapeutic challenges They are painful, foul smelling and difficult for the patient to care for. An additional problem is occasionally disabling trigeminal neuralgia. He has had many well-differentiated SCCs excised over the past decade. He has atrial fibrillation, Factor 5 deficiency and is on warfarin and a host of cardiac medication.
O/E: Wide-spread erythema and scale covering entire integument except head and neck. There is a 3 cm exophytic tumor of the left pre-tibial area and smaller similar tumors on right leg, back and chest.
Clinical Photos (6.6.17)
Questions: Should these lesions be excised? Should we consider one of the new targeted therapies? Do any of our members have expertise with them? This man has a number of co-morbidities which may make therapy more difficult.