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.