Squamous cell carcinoma arising in chronic hidradenitis suppurativa: A case report and comprehensive literature review

Introduction: Hidradenitis Suppurativa (HS) is a chronic inflammatory disorder that affects the pilosebaceous unit. Squamous Cell Carcinoma (SCC) can emerge as a complication. Presentation of case: A 58-year-old male patient with a history of smoking, obesity, and type 2 diabetes was initially managed by a dermatology team for Follicular Occlusion Syndrome manifesting as HS. Despite clinical treatment, the patient was referred to the Coloproctology Unit because of the development of a lesion in the perianal region near the HS lesions. Physical examination revealed an ulcerated, vegetative, painful, and friable lesion in the right perianal region consistent with SCC of the HS scar. The patient underwent chemotherapy and radiotherapy, but the lesions recurred, necessitating abdominoperineal amputation of the rectum. Discussion: Although rare, patients with chronic HS are at an increased risk of developing SCC, particularly in the perineal and gluteal regions. The standard treatment protocol for SCC in HS involves chemoradiotherapy with the aim of preserving the anal sphincter and avoiding surgery. Surgical intervention is reserved for patients that are unresponsive to chemoradiotherapy or for advanced cases in which local resection is insufficient. Conclusion: This disease course aligns with the epidemiology of HS, which predominantly affects male individuals with chronic lesions in the perianal, gluteal, and perineal regions. Such lesions can progress severely, often resisting non-invasive treatments and requiring more aggressive surgical interventions.