Background. Verrucous squamous cell carcinoma is a rare form of squamous cell carcinoma characterized by slow growing exophytic tumors, verrucoid papule or plaque that develop at sites of chronic irritation. It is usually seen in the oral cavity, larynx, esophagus and skin, however it may also present elsewhere in the body. It was defined by Ackerman in 1948 as a diagnostically problematic squamous cell carcinoma. The standard of care for squamous cell carcinoma is a combination of surgery, systemic chemotherapy and radiation therapy, however radiation therapy is not available in our region.

Objective. The objective of this study is to present a rare case of verrucous squamous cell carcinoma presenting as a non-healing wound on the scalp managed with chemotherapy using docetaxel and carboplatin.

Case Summary. This is a case of a 61-year-old Filipino male from Daram, Samar, presenting with non-healing wound on the scalp. The patient had a hyperpigmented palpable nodule approximately <1cm on the scalp which he constantly scratched and peeled off. The lesion progressed into a 2x2cm hyperpigmented plaque. After a few weeks, hyperpigmented plaques on other parts of the scalp were noted and on the posterior right auricular area. Hyperpigmentation on the right side of the face was manifested, for which antibiotics and antifungals were given however, lesions persisted. Diagnostic workup was done in our institution and he underwent wide excision of the hyperpigmented plaque on the scalp. Biopsy report revealed a well-differentiated verrucous squamous cell carcinoma of the scalp. He underwent three cycles of chemotherapy with docetaxel and carboplatin and had significant reduction of the lesions.

Learning Points. The case was not immediately identified as a malignant entity; hence it was initially managed as skin and soft tissue infection. Therefore, a high index of malignancy suspicion should be taken on lesions that manifest with broadening and non-healing characteristics particularly in sun-exposed cutaneous regions.

Conclusion. Despite being in a resource limited setting, a trial of surgery and chemotherapy with docetaxel and carboplatin was able to reduce the size of lesions of verrucous squamous cell carcinoma on the scalp.

Keywords. verrucous squamous cell carcinoma, scalp, scalp tumors, docetaxel, carboplatin

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