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+A 57-year-old Jewish man with Crohn's disease (CD) of the ileum diagnosed at the age of thirteen, presented with multiple nonmelanoma skin cancers (NMSCs); these had developed over the past 16 years coinciding with the initiation of a prolonged course of the thiopurine 6-mercaptopurine (mercaptopurine, 6-MP).
+He was diagnosed with a total of 84 NMSC: 72 NMSC at our clinic, 12 from other clinics.
+He was also awaiting biopsy and removal for additional lesions.
+His CD was initially treated with sulfasalazine and intermittent steroids at diagnosis, but for the past 20 years he had been taking 6-MP daily.
+In the first ten years after beginning 6-MP he developed 30 NMSC; 14 were squamous cell carcinoma (SCC) and 16 were basal cell carcinoma (BCC).
+The patient was then treated elsewhere for the subsequent ten years.
+This past year, however, he returned to the clinic with over 100 new lesions suggestive of malignancy on his torso and extremities.
+Subsequent to this exam, he had 42 biopsy-proven lesions of NMCS; 20 were SCC and 22 were BCC.
+In addition, three of the SCCs were moderately differentiated and two were poorly differentiated and some of his larger skin cancers have necessitated Mohs surgery and xenografting.
+The largest of his lesions was pretibial and measured 64x53 mm (Figure 1).
+He was awaiting biopsy for many other suspicious lesions.
+The patient had Fitzpatrick II skin type and admitted to excessive sun exposure for 25 years in Hawai‘i.
+Early on he did not use sunscreen, and would sail a catamaran during peak sun hours.
+He also revealed that his mother had one skin cancer lesion removed and denied ever having been a smoker.
+Within the past year he discontinued 6-MP and began using mesalamine (Pentasa) and later adalimumab (Humira) hoping to attenuate the progression of NMSC, and continued to have monthly skin exams.
+Overall, he was hospitalized 16 times for his CD, but never required any intestinal resection.
+Unfortunately, in his most recent hospitalization he was diagnosed with metastatic adenocarcinoma of the small bowel, and passed away shortly after.