Squamous cell carcinoma arising in smallpox vaccination scar

This is a red macule with thick scales on the left arm of a man (fig 1) in his 60s. The patient had been vaccinated for smallpox at the site more than 40 years previously. For six months the itchy lesion had developed over the scar and had not improved with intermittent use of different topical steroids. A skin biopsy confirmed squamous cell carcinoma.bmj;379/nov30_3/e070440/F1F1f1Fig 1Smallpox immunisation with vaccinia virus leaves a slightly depressed, smooth scar at the site of vaccination. Although rare, benign and malignant tumours have been reported at these vaccination sites, such as squamous cell carcinoma, basal cell carcinoma, melanoma, dermatofibrosarcoma protuberans, and malignant fibrous histiocytoma.123
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