What is the treatment for arthritis associated with squamous cell carcinoma?

Treatment of Arthritis Associated with Squamous Cell Carcinoma

For arthritis associated with squamous cell carcinoma, surgical resection of the primary tumor with or without adjuvant radiation therapy and possible systemic therapy is recommended as the primary treatment approach. 1

Primary Treatment Options

Surgical Management

• Surgical resection is the cornerstone of treatment for squamous cell carcinoma (SCC) with associated arthritis, as removing the primary malignancy is essential for resolving the paraneoplastic arthritis 1
• For cutaneous SCC, treatment options depend on risk stratification:
  • Low-risk primary cSCC: Standard excision with 4-6 mm margins to mid-subcutaneous adipose tissue depth 1
  • High-risk cSCC: Mohs micrographic surgery (MMS) is recommended for optimal margin control 1
• Complete tumor resection is critical as it's associated with improved long-term survival and resolution of paraneoplastic symptoms 1

Radiation Therapy

• If surgical therapy is not feasible or preferred, radiation therapy can be considered, though cure rates may be lower 1
• For locally advanced disease, combination chemoradiation therapy should be considered for inoperable disease 1
• Radiation therapy options include superficial radiation therapy, brachytherapy, and external electron beam therapy 1

Systemic Therapy for Advanced Disease

• For metastatic disease, epidermal growth factor receptor (EGFR) inhibitors and cisplatin (as single agent or in combination therapy) may be considered 1
• Cisplatin as a single agent or combined with 5-fluorouracil has the strongest evidence for treatment of metastatic SCC 2
• Intra-arterial cisplatin has been reported as a treatment option for advanced regional SCC 3

Management of Paraneoplastic Arthritis

• Paraneoplastic arthritis associated with SCC typically resolves after successful treatment of the primary malignancy 4
• Case reports demonstrate complete resolution of polyarthritis and vasculitic symptoms within months after treatment of the underlying SCC 4
• While awaiting resolution, symptomatic treatment of arthritis may include:
  • NSAIDs such as naproxen for pain management and anti-inflammatory effects 5
  • Caution with immunosuppressive agents as they may potentially promote tumor growth 6

Special Considerations

• Multidisciplinary consultation and management is recommended for patients with locally advanced or metastatic disease 1
• Regular follow-up is essential after treatment:
  • After diagnosis of SCC, screening for new keratinocyte cancers should be performed at least annually 1
  • Patients should be counseled on skin self-examination and sun protection 1
• For patients with rheumatoid arthritis who develop SCC, careful consideration of immunosuppressive therapy is needed, as TNF-α inhibitors have been associated with development of SCC in some cases 6

Treatment Algorithm

1. Confirm diagnosis: Biopsy of both the SCC and affected joint if necessary 1
2. Stage the malignancy: Determine extent of disease and presence of metastases 1
3. Primary treatment: Surgical resection of the tumor when possible 1
4. Adjuvant therapy: Consider radiation and/or systemic therapy based on staging and risk factors 1
5. Monitor arthritis symptoms: Expect improvement after successful treatment of primary malignancy 4
6. Follow-up care: Regular screening for recurrence or new skin cancers 1

The prognosis for paraneoplastic arthritis associated with SCC is generally good if the primary malignancy can be successfully treated, with most patients experiencing resolution of arthritic symptoms following treatment of the underlying cancer 4.