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Risk of squamous cell carcinoma in junctional epidermolysis bullosa, non-Herlitz type: report of 7 cases and a review of the literature.
[junctional epidermolysis bullosa]
Squamous
cell
carcinoma
(
SCC
)
is
the
most
severe
complication
and
most
common
cause
of
death
in
patients
with
recessive
dystrophic
epidermolysis
bullosa
.
The
risk
of
developing
SCC
among
patients
with
junctional
epidermolysis
bullosa
(
JEB
)
is
unclear
from
the
literature
;
however
,
in
our
center
we
noticed
an
unexpected
number
of
SCCs
among
adult
patients
with
JEB
.
To
review
all
documented
patients
with
JEB
in
whom
an
SCC
developed
,
both
from
our
epidermolysis
bullosa
(
EB
)
center
and
those
reported
in
the
literature
.
A
search
in
our
EB
registry
documenting
all
JEB
patients
visiting
our
EB
referral
center
from
1990
through
2010
revealed
7
JEB
patients
who
developed
1
or
more
SCCs
.
A
systematic
literature
search
revealed
8
relevant
articles
documenting
a
total
of
7
patients
who
developed
an
SCC
.
In
our
EB
registry
we
found
7
patients
with
JEB
who
developed
an
SCC
;
these
were
all
adults
classified
with
non-
Herlitz
type
JEB
.
The
frequency
of
developing
an
SCC
among
adult
JEB
patients
(
n
=
28
)
in
our
center
was
therefore
25
%
.
In
the
literature
,
we
found
7
case
reports
of
JEB
complicated
by
SCC
(
also
classified
as
JEB
,
non-
Herlitz
type
)
,
bringing
the
total
number
of
documented
cases
to
14
.
The
first
SCC
in
JEB
patients
developed
at
an
average
age
of
50
years
(
median
,
52
years
;
range
,
28
-
70
years
)
.
In
9
of
14
cases
,
multiple
primary
SCCs
occurred
,
with
a
total
of
45
SCCs
.
The
SCCs
are
most
often
located
on
the
lower
extremities
,
in
areas
of
chronic
blistering
,
long
-standing
erosions
,
or
atrophic
scarring
.
Three
patients
(
21
%
)
developed
metastases
and
died
on
average
8
.
9
years
after
diagnosis
of
the
initial
SCC
.
T
his
study
was
retrospective
and
the
statistical
analyses
were
based
on
a
small
number
of
patients
.
From
their
third
decade
,
adult
patients
with
JEB
have
an
increased
risk
(
1
:
4
)
of
developing
SCC
on
their
lower
extremities
.
The
SCCs
have
a
high
recurrence
rate
and
follow
an
aggressive
course
that
results
in
death
in
1
of
5
patients
.
We
recommend
annual
checks
of
all
JEB
patients
for
SCC
starting
at
25
years
of
age
.
Diseases
Validation
Diseases presenting
"total number"
symptom
child syndrome
classical phenylketonuria
congenital toxoplasmosis
cystinuria
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
heparin-induced thrombocytopenia
junctional epidermolysis bullosa
kindler syndrome
liposarcoma
megacystis-microcolon-intestinal hypoperistalsis syndrome
monosomy 21
oral submucous fibrosis
scrub typhus
typhoid
well-differentiated liposarcoma
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