Ref. # 111601
An adult male had undergone a kidney and pancreas transplant and took the requisite immunosuppressive drugs. Five years post-transplant he began treatment at a dermatology and skin cancer clinic for a large lesion on the right thumb and smaller lesions on the left middle finger. The lesions were identified as warts. The patient underwent six therapeutic sessions with a Versapulse laser. The lesions continued to grow, accompanied with pain and bleeding. Seven months later the patient sought evaluation with a hand surgeon, who ordered a biopsy which showed squamous cell carcinoma. A partial amputation of the thumb was performed, followed a month later by a similar operation for the left middle finger. A medQuest dermatopathologist reported it is well known that patients taking immunosuppressive medication following solid organ transplantation have an increased incidence of and risk from non-melanoma skin cancer, specifically squamous cell carcinoma. These lesions may mimic warts. Standard of care required a biopsy much earlier when the patient failed to respond to conventional treatment. The clinic's records failed to mention the actual size of the lesions and include drawings of the malignancy-either before or during treatment. A timely biopsy would have diminished the need to remove the thumb entirely.