Zosteriform cutaneous metastases from squamous cell carcinoma of the stump of an amputated arm

The clinical appearance of skin metastases varies over a wide morphologic spectrum, cutaneous metastases mimicking herpes zoster being rare. We now report the case of an 83-year-old male with zosteriform cutaneous metastases secondary to a squamous cell carcinoma (SCC) which developed in the stump of an amputated arm. The pathogenesis is speculative, but in this case, the zosteriform distribution might well be explained by perineural lymphatic invasion and spread.     

Zosteriform and epidermotropic metastatic primary cutaneous squamous cell carcinoma

The first case of primary cutaneous squamous cell carcinoma (SCC) to cause zosteriform and epidermotropic metastasis to skin is reported. The patient is a 72-year-old Japanese woman. A cutaneous SCC appeared on the lateral side of her right knee and was removed. After dissection of the right inguinal lymph nodes, which revealed metastases, and irradiation of the right inguinal region, the patient presented with slightly pruritic and painful erythematous papules on the right hip and small brownish papules and vesicles with crusts on the anterior side of the right thigh. The eruptions were in a zosteriform distribution along the right L1 to L3 dermatomes. Histologically neoplastic squamous cell nests were observed in the epidermis, below the epidermal-dermal junction, and within lymphatic vessels in the deeper reticular dermis. We postulate that neoplastic cells with the ability to fuse with adjacent squamous epithelium may have been carried beneath the basal lamina or to the epidermis via dermal lymphatic backflow, resulting in epidermotropic metastasis.     

Cutaneous metastasis of prostate cancer: a case report and review of the literature with bioinformatics analysis of multiple healthcare delivery networks

Distant cutaneous metastases of prostate carcinomas are extremely rare, despite its high incidence and prevalence. Most cases are either a result of local extension, such as into seminal vesicles or distant metastases to bone. Few cases of true cutaneous metastatic prostate carcinoma exist in the literature. Clinically, cutaneous prostate carcinoma has been reported to mimic many other conditions, such as cellulitis, sebaceous cysts, zosteriform lesions, telangectasias and more, resulting in poor recognition. We report a case of distant cutaneous metastasis of prostate carcinoma and recent review of the literature with an analysis of de‐identified patient records from multiple healthcare delivery networks. A diagnosis of metastatic prostate carcinoma may have been easily overlooked given the location and nature of the rash. Reviewing case reports and using aggregated electronic health records (EHRs), we find that fewer than 0.1% of all prostate carcinomas result in cutaneous metastases, compared with much higher rates in other types of cancers. Coupled with the low frequency of metastases to skin, careful consideration must be taken when evaluating a rash in a patient with a prior history of cancer. A complete clinical history and strong suspicion would be required to make a diagnosis of cutaneous metastases of the prostate.     

Availability of sentinel lymph node biopsy for cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma is the second common cutaneous cancer, especially in the elderly. Sentinel lymph node biopsy is generally performed in breast cancers and cutaneous melanomas to detect occult nodal metastases. The benefit of sentinel lymph node biopsy in improving cutaneous squamous cell carcinoma prognosis is doubtful. One hundred and sixty‐nine patients who underwent treatment for cutaneous squamous cell carcinoma between 2004 and 2015, and who were followed up for at least 6 months or developed metastases within the follow‐up period were included. Forty‐nine patients underwent sentinel lymph node biopsy, whereas 120 patients did not, including 13 who exhibited clinical lymph node metastases before treatment. Of these 49 patients, nine (18.4%) presented with sentinel lymph node metastasis, which occurred after treatment in three (6.1%) of them (false‐negative). Among the 107 patients who did not undergo lymph node biopsy, 12 (11.2%) developed post‐treatment metastases. The metastasis‐free and disease‐specific survival rates were not significantly different in those who did or did not undergo sentinel lymph node biopsy. Patients with clinical lymph node metastases had a higher risk compared with those without. Patients with T2–T4 tumors had a higher risk compared with those with T1 tumors. When selecting for those with T2 tumors or greater, the same lack of relationship was observed. In conclusion, in this small retrospective cohort, in patients with cutaneous squamous cell carcinoma, there were no significant differences in metastasis‐free and disease‐specific survival rates between those who did or did not undergo sentinel lymph node biopsy, regardless of T staging.     

Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia

In patients with chronic lymphocytic leukemia, squamous cell carcinoma behaves aggressively. Our purpose was to compare squamous cell carcinoma metastasis and mortality between patients with chronic lymphocytic leukemia and control subjects. Medical records were assessed retrospectively for 28 patients with chronic lymphocytic leukemia who underwent surgical excision of cutaneous squamous cell carcinoma and for 56 matched control subjects. The rate of metastasis and mortality from cutaneous squamous cell carcinoma were determined on a per-patient basis. Three of 28 patients with chronic lymphocytic leukemia had metastasis and died of metastatic disease. No metastases or deaths occurred among the 56 control subjects. Compared with control subjects, chronic lymphocytic leukemia patients with cutaneous squamous cell carcinoma were more likely to have metastasis (P = .0031) and die of metastasis (P = .0033). No significant association was detected between metastasis and history of chemotherapy administration for chronic lymphocytic leukemia. Among patients with chronic lymphocytic leukemia, surveillance for skin cancer and a decreased threshold for biopsy of suspect lesions are warranted.     

Managing patients with cutaneous squamous cell carcinoma metastatic to the axilla or groin lymph nodes

Cutaneous squamous cell carcinoma accounts for 20% of all non‐melanoma skin cancer with a minority arising on the trunk and extremities. A small proportion will develop metastases to regional nodes of the axilla or groin. We performed a retrospective review of patients with metastatic cutaneous squamous cell carcinoma to the axilla and groin treated at Westmead Hospital, Sydney. The purpose of this study was to document the treatment and outcome of these patients. We identified 18 men and 8 women with a median age of 73 years. Median follow‐up was 18.5 months. Median lesion size was 27 mm (range 3–130 mm) and median thickness was 7 mm (range 3–32 mm). Nine patients developed metastases to the groin, 14 to the axilla, 1 in the epitrochlear, and 2 to both the epitrochlear and axillary lymph nodes. All patients were treated with surgery +/? radiotherapy. Recurrence developed in seven patients (27%) with most developing distant metastases. Most (6/7) patients with recurrence died. Predicting patients that may develop nodal metastatic non‐head and neck cutaneous squamous cell carcinoma is difficult. Following diagnosis, surgery remains the primary treatment and select patients with unfavourable features, such as extranodal spread, may benefit from the addition of adjuvant radiotherapy.     

Epidermotropic metastases from breast carcinoma showing different clinical and histopathological features on the trunk and on the scalp in a single patient

A 54-year-old female presented with the cutaneous metastases of the breast carcinoma that produced combination of pigmented zosteriform eruption on the trunk and eroded plaque on the scalp, 13 years after radical mastectomy. Histologically, zosteriform lesions displayed prominent infiltration of the epidermis in nesting or linear pattern by neoplastic cells with focal formation of intraepidermal and subepidermal vesicles due to discohesion of tumor cells and dermal edema. Examination of scalp plaque revealed ulcerations and infiltration of the epidermis with scattered basal and suprabasal malignant cells in pagetoid fashion. Immunohistochemically, tumor cells were cytokeratin 7- and estrogen receptor-positive and cytokeratin 20 negative. HMB-45 and Melan-A-stained numerous dendritic melanocytes intermingled with intraepidermal and superficial dermal tumor cells in the trunk lesion, whereas on the scalp, only occasional melanocytes surrounding intraepidermal carcinomatous cells were identified. Our case described, to our knowledge, so far unreported combination of individually rare, clinical and histological patterns of cutaneous metastases from breast carcinoma in a single patient.     

Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics,frequency of local recurrence and metastasis

BACKGROUND

squamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases.

OBJECTIVE

The objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis.

METHODS

A retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations.

RESULTS

Sixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders'' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders'' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins.

CONCLUSIONS

Most patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.     

Defining patients with high-risk cutaneous squamous cell carcinoma

SUMMARY Non-melanoma skin cancers occur at an epidemic rate in Australia. With an ageing population more Australians will develop these cancers and at an increasing rate. In the majority of cases, local treatment, usually excision, is highly curative. However, a subset of the population are diagnosed with a high-risk cutaneous squamous cell carcinoma, defined as a patient having a higher risk of subclinical metastases to regional lymph nodes based on unfavourable primary lesion features and patient factors. Despite treatment, patients developing metastatic cutaneous squamous cell carcinoma experience mortality and morbidity usually as a consequence of uncontrolled metastatic nodal disease. It is therefore important that clinicians treating skin cancers have an understanding and awareness of these high-risk patients. The aim of this article is to discuss the features that define a high-risk patient and to present some of the issues pertinent to their treatment.     

A case of multiple Bowen's disease with squamous cell carcinoma of the larynx and adenocarcionoma of the prostate

Bowen's disease, or cutaneous squamous cell carcinoma in situ, has been regarded as a cutaneous marker for internal malignancy. However, the relationship of Bowen's disease to visceral cancers remains controversial. We present a 76-year-old male with multiple lesions of Bowen's disease, who later developed laryngeal cancer and subsequent prostate cancer with distant metastases. Efforts to detect possible common etiologic agents including human papillomavirus and chronic arsenicism revealed no association between Bowen's disease and the internal malignancies. Despite the controversy, we suggest that a conservative cancer workup is ethically indicated in patients with multiple Bowen's disease.     

Zosteriform cutaneous metastases from breast adenocarcinoma

Cutaneous metastases from breast adenocarcinoma are usually nodular, single or multiple. Their zosteriform distribution is very rare. We present a 54-year-old woman with cutaneous zosteriform nodular metastases on the right side of her thorax, and infiltration of the corresponding arm, 3 months after the excision of adenocarcinoma of her right breast.     

Topical combination therapy for cutaneous squamous cell carcinoma in situ with 5-fluorouracil cream and imiquimod cream in patients who have failed topical monotherapy

Topical therapeutic options for cutaneous squamous cell carcinoma in situ include 5-fluorouracil cream and imiquimod cream. Such treatment may be preferable to surgical or destructive modalities in certain anatomic locations and in instances where patients are unwilling or poor surgical candidates. We present 4 such patients with cutaneous squamous cell carcinoma in situ involving a digit. Each patient failed treatment with imiquimod cream as monotherapy. In addition, two patients failed treatment with 5-fluorouracil cream as monotherapy. All 4 responded completely to 5-fluorouracil and imiquimod cream as combination therapy. In patients who have failed monotherapy with a topical agent for cutaneous squamous cell carcinoma in situ, combination treatment using both topical 5-fluorouracil cream and imiquimod cream may be considered as an alternative therapeutic strategy.     

Zosteriform skin metastases: clue to an undiagnosed breast cancer

Cancer metastases represent the most devastating aspect of malignancy, since the mortality of cancer patients is mainly related to the metastatic behavior of the primary neoplasm. Skin metastases are usually late events in the course of tumor progression. Excluding melanoma, the most common tumor to metastasize to the skin is breast cancer. Patients who develop cutaneous metastases rarely present with a zosteriform distribution. Herein, we present a 60-year-old female, an undiagnosed case of breast cancer, with zosteriform metastases along her right T2-T3 dermatome.     

Metastatic Zosteriform Squamous Cell Carcinoma in an Immunocompetent Patient

Background Although described in several reports of internal malignancies metastasizing to the skin, zosteriform metastases have been reported in only two cases of cutaneous squamous cell carcinoma (SCC). In both of these reports, the patients were immunosuppressed related to renal transplantation. Objective We present a case of an immunocompetent patient with zosteriform metastases originating from a recurrent cutaneous SCC. The lesions were present along the maxillary division of the trigeminal nerve. Methods Biopsies from eight lesions were studied using hematoxylin and eosin (H&E) and with immunohistochemistry. Results Neural involvement was detected in H&E preparations before and during excision of the metastatic nodules by Mohs micrographic surgery. The tumor cells reacted with antikeratin antibodies. The patient has had no evidence of recurrence or metastases 30 months following surgery. Conclusion To our knowledge, this is the first case of cutaneous SCC with zosteriform metastases in a patient with an intact immune system. SCC should be included in the differential diagnosis of lesions presenting in a dermatomal distribution.

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Sommaire Antécédents Bien qu'elles aient été décrites dans plusieurs rapports sur les tumeurs malignes qui se métastasent au niveau de la peau, les métastases zostériformes n'ont été rapportées que dans deux cas de carcinomes squameux (CS). Dans ces deux cas, les patients étaient immunodépressifs à la suite d'une transplantation rénale. Objectif Nous présentons le cas d'un patient immunocompétent souffrant de métastases zostériformes provenant de CS récurrents. Les lésions se trouvaient dans la branche maxillaire du nerf trijumeau. Méthodes Des biopsies de huit lésions ont été étudiées au moyen d'une coloration à l'hématoxyline–eosine (Hé) et par immunohistochimie. Résultats La lésion neuronale a été détectée grace à la coloration Hé avant et durant l'excision des nodules métastatiques au moyen de la chirurgie micrographique de Mohs. Les cellules tumorales ont interagi avec les anticorps anti-kératines. Trente mois après la chirurgie, le patient ne présentait aucune récurrence ni métastase. Conclusion à notre connaissance, il s'agit du premier cas de CS avec métastases zostèriformes chez un patient ayant un système immunitaire intact. Les CS doivent être inclus dans le diagnostic différentiel des lésions présentes dans les distributions dermatomales.

     

Aggressive intranasal carcinoma mimicking infection or inflammation

In a twenty-year period we have treated five patients with intranasal squamous cell carcinomas who initially were thought to have benign cutaneous disorders of the nasal skin. Advanced squamous cell carcinoma requiring total rhinectomy, often with extensive contiguous midface excision, was found in all patients. Three of these five patients died of their disease. In one patient, a red nose resembling acne rosacea was present. In the four others, chronic cellulitic or ulcerative cutaneous involvement was caused by squamous cell carcinoma. These cases emphasize the need for intranasal examination and appropriate radiologic studies to exclude intranasal carcinoma in patients with apparently unresponsive cutaneous nasal disease.     

Anti-oncogram-oriented polychemotherapy in metastasizing squamous cell carcinoma of the skin: impressive partial remission]

Metastatic squamous cell carcinoma of the skin is associated with a poor prognosis even after surgical treatment or irradiation. Polychemotherapy can be used as an alternative regimen. We present a 65-year-old male patient with extensive metastatic squamous cell carcinoma of the skin after multiple surgical treatment and radiation. A combination of bleomycin, methotrexate and cisplatin, planned according to the anti-oncogram, resulted in rapid partial remission of the cutaneous metastases over several months.     

Head and neck squamous cell carcinoma skin metastases below of the diaphragm

Cutaneous metastases from carcinoma are relatively uncommon in clinical practice. Metastasis to skin sites from squamous cell carcinoma of the mucosa of the head and neck are also very rare. However, skin metastases may be the first clinical evidence of the malignant disease or its loco-regional recurrence. Early recognition of skin metastasis can lead to an accurate and prompt diagnosis and timely treatment. Patients with skin metastases have very poor prognosis. We report on four such patients, one of them with multiple skin metastases from the squamous cell carcinoma in the cervical part of the esophagus above and below the level of the diaphragm. In reviewing the literature, only two cases of solitary skin metastases below the diaphragm from laryngeal squamous cell carcinomas have been reported     

Primary cutaneous adenosquamous carcinoma: a case report and review of the literature

BACKGROUND: Adenosquamous carcinoma (ASC) of skin is a rare but distinctive neoplasm that usually exhibits an aggressive course. To date, 13 well-documented and undisputed cases of primary cutaneous ASC have been reported. This term has been used for tumors with better prognosis, such as mucoepidermoid carcinomas and acantolytic squamous cell carcinomas, originating confusion. We report a primary cutaneous ASC and review the literature. METHODS: In this report a woman with primary ASC of the skin was studied. Histopathological examination and immunohistochemical stains were performed. RESULTS: The tumor had two components: conventional squamous cell carcinoma merging with adenocarcinoma. After a local recurrence and lymph node metastases, the patient has no evidence of disease 8 months later. CONCLUSIONS: Pathologists should reserve the term ASC for tumors exhibiting the above mentioned appearance. In such circumstances, a metastatic origin must always be excluded.     

Human beta papillomavirus DNA study in primary cutaneous squamous cell carcinomas and their corresponding metastases

The association between beta human papillomavirus (HPV) types and cutaneous squamous cell carcinomas (cSCCs) is controversial. Several studies have found such an association, especially at early stages of carcinogenesis, but the presence of beta HPV types in aggressive cSCCs has only been reported in three patients previously. We aimed to search for beta HPV DNA in primary cSCCs and their corresponding lymph node metastases in a series of patients. The presence of DNA from 25 beta HPV types was determined using a multiplex PCR protocol in 35 primary cSCCs from 35 patients and their corresponding lymph node metastases. DNA from beta HPV types was detected in 9 % of primary cSCCs and in 13 % of metastases. No primary cutaneous SCC or lymphatic metastases were found to share the same HPV DNA. These data suggest that beta HPV types do not play an etiopathogenic role in advanced stages of squamous cell carcinogenesis.     

Metastases in dermatological patients with squamous cell carcinoma.

Two hundred eleven patients in whom squamous cell carcinoma (SCC) of the skin had been diagnosed between 1950 and 1959 were followed up from Jan 1, 1976, to establish the incidence of metastases. A systemic study was carried out through follow-up examinations and tracing through population registers. We found 3.3% metastases in 153 patients with skin SCC and 11% metastases in 55 patients with labial SCC. Three patients with genital SCC were free of metastases. These results and the available literature on patients with SCC of osteomyelitic foci and scars from burns or x-ray treatment indicate that sharp distinctions must be made among three groups of SCC; mucocutaneous, primary cutaneous, and cutaneous SCC secondary to inflammatory and degenerative processes. The incidence of metastases in the three groups is approximately 11%, 3%, and 10% to 30%, respectively. Percentages found are important to dermatology clinics because skin SCC should be considered a malignant tumor with a higher incidence of metastases than previously assumed.