Squamous cell skin carcinoma due to chronic sacrococcygeal diseases

Introduction/Objective. Sacrococcygeal region squamous cell cancers (SCC) due to chronic sacrococcygeal diseases of skin are rare malignancies. The anatomical relation with the anus represents a challenge for diagnosis and surgical treatment. The oncological treatment algorithm is still controversial. Here, we investigated the clinicopathologic features of skin cancer of the sacrococcygeal region in a total of 10 cases from a surgical oncology reference center. Methods. We retrospectively analyzed the patients who underwent surgery for sacrococcygeal region skin SCC between January 2010 and July 2020. Results. All patients were male, and the mean age was 52.9±10.5 years. In the etiology, five patients had hidradenitis suppurativa, 2 had Human papillomavirus associated condyloma (Buschke-Lowenstein tumor), and 3 had pilonidal sinus disease. The mean time between the development of the lesion and malignancy diagnosis was 21.7±5.8 years. In the preoperative evaluation, three patients had bone invasion. None of the patients had anal sphincter or rectal invasion. Also, no patient had lymph node metastasis or distant metastasis. Wide local excision (WLE) was performed in all patients; 3 of them with bone resection. Adjuvant chemoradiotherapy was applied to five patients. In a 28.5±13.7 months follow-up, local recurrence occurred in 5 patients and WLE has performed again in these patients. Of these 5 patients, 2 eventually became metastatic. Finally, 3 patients died due to disease and 6 patients are still free of diseases. Conclusion. Sacrococcygeal region SCCs may rarely develop after a long interval from hidradenitis suppurativa, pilonidal sinus disease, and condyloma acuminata. Anal sphincter-sparing WLE can be applied, but sphincter dysfunction may occur. The disease is associated with a high risk of relapse and poor survival.