Therapeutic Challenges in Managing Coexisting Hidradenitis Suppurativa and Squamous Cell Carcinoma: A Clinical Case Study

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder affecting intertriginous areas. Long‐standing HS can undergo malignant transformation into squamous cell carcinoma (SCC), particularly in the perineal and gluteal regions. We report a 54‐year‐old man with severe, treatment‐refractory HS complicated by an aggressive verrucous SCC in the perianal area. The patient underwent multiple systemic therapies—including adalimumab, secukinumab, and bimekizumab—combined with several surgical interventions for the HS. While adalimumab led to partial improvement of HS, concerns exist about its potential association with SCC development. Upon SCC recurrence, the patient was treated with the PD‐1 inhibitor cemiplimab, which triggered a severe HS exacerbation and complicated the clinical course. Subsequently, IL‐17 inhibitors were used to better control HS inflammation during oncologic management. Ultimately, radical surgery was necessary to achieve complete tumor excision. Patients with long‐standing HS should be regularly monitored for suspicious lesions, and atypical or non‐healing wounds should be promptly biopsied to enable early detection of malignant transformation. The management of coexisting HS and SCC is complex, as demonstrated in this case by the challenges of selecting and timing immunomodulatory therapies that adequately control inflammation without increasing cancer progression risk or provoking severe disease flares. Multidisciplinary, individualized treatment and close follow‐up are essential to optimize outcomes in these challenging cases.