Introduction: Cutaneous squamous cell carcinoma (cSCC) which is the second most common type of skin cancer after basal cell carcinoma arises in epidermal keratinocytes. Its etiology is multi-factorial, but one of the most important inducing factors is the exposure to UV radiations. The incidence in immunocompromised patients is higher and the tumor in this population is more aggressive with higher risk for metastasis. Incidence increases significantly with age.

Case Presentation: A 24-year-old man, with a history of dermatofibrosarcoma protuberans that was diagnosed 13 years ago and treated with surgical excision, radiotherapy and Imatinib, presented for a left neck necrotic mass extending to the left shoulder. Biopsies were taken for diagnosis and revealed moderately differentiated squamous cell carcinoma that was managed with radiotherapy and surgical excision. Patient later developed lung metastasis that required palliative chemotherapy.

Discussion: Patients diagnosed with cutaneous squamous cell carcinoma are usually elderly and had a history of chronic UV radiation. On the contrary the case presented is a young man with a history of radiation therapy for dermatofibrosarcoma protuberans. It was a very aggressive tumor that required radical surgical intervention with several sessions of radiotherapy and followed by chemotherapy due to the presence of lung metastasis.

Conclusion: Patients with history of any type of skin cancer and those exposed to radiation (even therapeutic) must be followed up carefully for a possible development of cutaneous squamous cell carcinoma even at young ages where it is usually rare for cSCC to occur.

Keywords: Cutaneous squamous cell carcinoma; Dermatofibrosarcoma protuberans; Radiation; Surgery; Metastasis