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Dermatology

Lip Squamous Cell Carcinoma With Spontaneous Eruption and Drainage

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: February 2, 2023

Clinical Challenge

Article Information and Disclosures

Tiffany Toni, BS¹;

Clint T. Allen, MD¹;

Wojciech K. Mydlarz, MD²

Author Affiliations

¹Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
²Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

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A 69-year-old woman with a newly diagnosed T3N2cM0 poorly differentiated squamous cell carcinoma unrelated to human papillomavirus (HPV) of the lower lip mucosa presented to the medical oncology clinic 3 days after initiating neoadjuvant immune checkpoint blockade immunotherapy with redness and swelling of the tumor site. Four days after treatment, a white head formed overlying the tumor that erupted through the skin surface (Figure 1). Thin, cloudy discharge that was not foul-smelling drained from the tumor from posttreatment days 5 to 10, at which point the drainage stopped spontaneously. Throughout, the patient reported no pain and remained afebrile. Laboratory results on days 5, 9, and 14 demonstrated the absence of leukocytosis, and serial wound cultures failed to demonstrate pathogenic growth. No antibiotics were administered. The patient completed the neoadjuvant immunotherapy and underwent a margin-negative tumor resection without intraoperative or postoperative complications.

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A 69-year-old woman with a newly diagnosed T3N2cM0 poorly differentiated squamous cell carcinoma unrelated to human papillomavirus (HPV) of the lower lip mucosa presented to the medical oncology clinic 3 days after initiating neoadjuvant immune checkpoint blockade immunotherapy with redness and swelling of the tumor site. Four days after treatment, a white head formed overlying the tumor that erupted through the skin surface (Figure 1). Thin, cloudy discharge that was not foul-smelling drained from the tumor from posttreatment days 5 to 10, at which point the drainage stopped spontaneously. Throughout, the patient reported no pain and remained afebrile. Laboratory results on days 5, 9, and 14 demonstrated the absence of leukocytosis, and serial wound cultures failed to demonstrate pathogenic growth. No antibiotics were administered. The patient completed the neoadjuvant immunotherapy and underwent a margin-negative tumor resection without intraoperative or postoperative complications.

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Article Information

Corresponding Author: Wojciech K. Mydlarz, MD, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, JHOC 6210, 601 N Caroline St, Baltimore, MD 21287 (mydlarz@jhmi.edu).

Published Online: February 2, 2023. doi:10.1001/jamaoto.2022.4828

Conflict of Interest Disclosures: Dr Toni reported involvement with a Medical Research Scholars Program fellowship from the National Institutes of Health (NIH) during the submitted work. No other disclosures were reported.

Additional Contributions: We thank Chyi-Chia Richard Lee, MD, PhD, for his evaluation of the pathology specimen and critical review of the manuscript. This individual was not compensated for their contributions. We also thank the patient for granting permission to publish this information.

Additional Information: This research was made possible through the NIH Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, the American Association for Dental Research, the Colgate-Palmolive Company, and other private donors. For a complete list, please visit the Foundation website at http://fnih.org/what-we-do/current-education-and-training-programs/mrsp.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.