Recurrent Cutaneous Squamous Cell Carcinoma Secondary to Immunosuppressive Therapy

Summary: Here we present a case of a 71 year old male with a past medical history of renal transplant secondary to IgA nephropathy in 2021 on tacrolimus and prednisone and cutaneous squamous and basal cell carcinomas status posts photodynamic therapy, 5- fluorouracil, and Mohs surgery who presented in January for non healing lesions of left cheek and central forehead adjacent to previous Mohs scars respectively. This patient was found to have dermal deposition of poorly differentiated cutaneous squamous cell carcinoma and underwent excisional salvage therapy and local flap graft reconstruction. Postoperative course was complicated by flap graft infection treated with wound debridement and a course of antibiotics. The patient was found to have progressive gross residual in-transit dermal metastases at the graft site for which he was started on cemiplimab. Unfortunately, the patient was found to have graft rejection secondary to cemiplimab after two cycles of therapy. The patient is placed on hemodialysis and cemiplimab is being discontinued at this time. Recent PET CT demonstrates no obviously evaluable disease. He has no clinical signs of cutaneous squamous cell carcinoma recurrence at this time.