Introduction:
Previous studies have demonstrated the effectiveness of treating cutaneous SCC with intra-lesional 9-valent human papillomavirus (HPV) vaccine. We report a case of an elderly patient with a hypertrophic squamous cell carcinoma (SCC) of the cheek, unable to have surgical excision under local anaesthetic which was managed with the intralesional 9-valent HPV vaccine.
Case:
A 99-year-old woman was referred to a dermatologist with a six-month history of an enlarging hypertrophic biopsy confirmed SCC of the right cheek, measuring 4cm in diameter. The lesion extended from lower eyelid-cheek junction superiorly, to the nose medially and the nasolabial fold inferiorly. The lesion had no keratoacanthoma clinical features and the patient no known history of HPV infection. There was no cervical lymphadenopathy. The SCC was unable to be treated surgically due to surgical comorbidities and advanced age. Biopsy confirmed a hypertrophic verrucal squamous cell carcinoma (SCC) in situ with probable invasive SCC. The patient was treated with an initial intramuscular (IM) HPV vaccination, followed by intralesional HPV vaccinations 4 and 8 months later.
Results:
There was a clinical improvement in the size of the lesion which commenced after the initial IM dose. 2 months after the final IL dose, the lesion was noted to be 1mm in diameter. There were no adverse events. Acitretin was not commenced due to the patient’s clinical improvement.
Conclusions:
IL and IM HPV vaccination may be an effective treatment of cutaneous SCC in elderly patients who are unsuitable for surgical resection. It also provides a treatment for those who do not meet the criteria for IgG4 monoclonal antibody cemiplimab. Controlled studies are needed to further determine the reproducibility and mechanism for using 9-valent HPV vaccination for cutaneous SCC treatment.