title: Oral Squamous Cell Carcinoma Presenting in a Patient Receiving Adalimumab for Rheumatoid Arthritis.
abstract: The efficacy of biologic agents in the treatment of inflammatory immune-mediated conditions has been clearly shown, but there also are numerous reports of adverse effects. Most reported adverse effects have been associated with tumor necrosis factor-α (TNF-α) inhibitors and include a possible increased risk of malignancy. There have been some reported cases of oral cancer developing in patients treated with TNF-α inhibitors. This case report describes a patient who was taking adalimumab for rheumatoid arthritis and who presented with a squamous cell carcinoma (SCC) in the mandible. Diagnosis was complicated because the clinical appearance was of a nonhealing extraction socket and the patient had a history of bisphosphonate therapy. An initial diagnosis of bisphosphonate-related osteonecrosis of the jaws was made, which delayed the commencement of appropriate treatment. This case highlights the importance of ruling out SCC in patients taking biological agents with unusual symptoms.
authors.affiliation: Registrar in Oral Surgery, Department of Oral and Maxillofacial Surgery and Oral Medicine, Dublin Dental University Hospital, Dublin, Ireland. Electronic address: annabeattie@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Beattie
authors.affiliation: Professor and Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery and Oral Medicine, Dublin Dental University Hospital, Dublin, Ireland.
authors.forename: Leo F A
authors.initials: LF
authors.lastname: Stassen
authors.affiliation: Associate Professor and Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery and Oral Medicine, Dublin Dental University Hospital, Dublin, Ireland.
authors.forename: Kumara
authors.initials: K
authors.lastname: Ekanayake
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011862:Radiography, Panoramic
chemical_list: D018501:Antirheumatic Agents; D000068879:Adalimumab