Hydroxyurea-induced cutaneous squamous cell carcinoma: A case report

BACKGROUND Hydroxyurea (HU) is a non-alkylating antineoplastic agent that is active in the S-phase of the cell cycle and inhibits the enzyme ribonucleoside reductase. HU is currently used to treat leukemia, sickle cell anemia, psoriasis, and chronic myeloproliferative disorders. Although HU is easy to use and effective and has high tolerance, there have been numerous reports of cutaneous complications during long-term therapy with HU. CASE SUMMARY We report a 67-year-old woman on long-term HU therapy for primary myelofibrosis who developed concurrent skin lesions during treatment. The first skin lesion appeared on the dorsum of her right hand in 2015. Despite continuous use of HU, her cutaneous changes were neglected. Approximately 3 years ago, she had multiple nodular and keratotic lesions on both hands with sharp margins, branny desquamation, and dotted hyperpigmentation. Furthermore, she developed acutely numerous ulcerative lesions on her hands and legs. Topical wound therapy with dressing changes and parenteral antibiotics was applied for management of the lesions. Most of the wounds healed after HU withdrawal. Lesions on both hands were replaced by scabs. Nevertheless, the wound on her left ankle reached 9 cm x 7 cm in size in January 2018. Pathology confirmed well-differentiated squamous cell carcinoma at the ulcer area. In addition, her left foot was severely affected and radical surgery with a below-the-knee amputation was suggested followed by preventive right groin nodal dissection. CONCLUSION In patients receiving continuous HU therapy, close dermatologic follow-up is critical for the early diagnosis and selection of appropriate treatment for cutaneous lesions.