PMC8190543_01
Pre-treatment recurrence of facial cSCC. (A) Extent of disease on the right cheek prior to starting treatment with intra-lesional IL-2. (B) Histological profile of facial lesions prior to starting intra-lesional IL2 (top 40X, bottom 100X magnification), showing poorly differentiated cSCC.
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In February 2020 five new lesions were identified ( Figure 1A ). Pathology now demonstrated poorly differentiated cSCC with lymphovascular invasion and positive margins ( Figure 1B ).
Post-treatment course with intra-lesional IL2 and imiquimod. (A) Complete response of facial lesions with resolving submandibular nodule. Arrows identify nodule and infraorbital area of healing (biopsied) skin. (B) Sustained complete resolution of facial cSCC three months following completion of treatment. (C) (left) Histological profile of excised submandibular nodule low magnification; (right) 20X magnification reveals residual high-grade cSCC with necrosis, a pronounced lymphocytic infiltrate, with no evidence of nodal tissue (D) (left) 40X magnification of biopsied, healing infraorbital skin showing ulceration and complete clearance of cSCC; (right) 100X magnification.
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Figure 2A ). For a number of reasons, including patient-reported severe pain with injections particularly at the site of the submandibular lesion, ongoing cost of medications, and costs associated with travelling back and forth for weekly treatment, we elected to proceed with excision of the residual submandibular lesion; at the same time, a representative biopsy of the right facial skin was taken as well. The submandibular lesion demonstrated residual high-grade cSCC with necrosis and a pronounced lymphocytic infiltrate but no evidence of nodal tissue ( Figure 2C ). Histological analysis of the right cheek skin revealed no evidence of any residual cSCC ( Figure 2D ). The area remains disease free 3 months post-treatment ( Figure 2B ).