American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Not Just Skin Deep: Distant Metastases from Cutaneous Squamous Cell Carcinoma

 

Portable chest x-ray on presentation (A) and follow-up computed tomography of the chest without contrast (B).

Portable chest x-ray on presentation (A) and follow-up computed tomography of the chest without contrast (B).

Cutaneous squamous cell carcinoma is the second most common cancer in the United States and has 5-year recurrence and metastasis rates of 8% and 5%, respectively.12 However, not all cutaneous squamous cell carcinomas are alike, and the size and location of the primary lesion confers a widely variable risk for recurrence and metastasis.

Case Summary

A 69-year-old man presented with 1 week of worsening constipation, nausea, vomiting, and abdominal pain, as well as an unintentional 30-pound weight loss over the past year. His past medical history was significant for prostate cancer treated with prostatectomy and a history of multiple skin cancers on his scalp, face, and ears requiring parotidectomy.

Vital signs were normal. Physical examination demonstrated a 2.5-cm ulcerated, hyperkeratotic lesion on the vertex scalp, multiple erythematous scaly plaques on the glabella, and cutaneous horns on the midline chest and left forearm. Wheezes were auscultated in the right lower lung field. The abdomen was benign.

The complete blood count and basic metabolic panel were unremarkable. Calcium was 9.4 mg/dL. Alkaline phosphatase was 244 IU/L. Chest x-ray revealed a 3.6-cm left perihilar nodule and right lower lung patchy opacities (Figure, panel A). Computed tomography of the chest revealed multiple mass-like opacities, including a 5-cm cavitary mass in the right lower lobe (Figure, panel B). Biopsy revealed the vertex scalp lesion as squamous cell carcinoma. The right lower lung lesion was biopsied and revealed poorly differentiated squamous cell carcinoma. Magnetic resonance imaging of the brain revealed 2 metastatic lesions. The presumptive diagnosis was metastatic cutaneous squamous cell carcinoma.

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-Ajay Major, MD, MBA, Mel Anderson, MD

This article originally appeared in the August 2017 issue of The American Journal of Medicine.

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