Bone metastases and hypercalcaemia from cutaneous squamous cell carcinoma

Abstract

DESCRIPTIONAn 83-year-old man presented with hypercalcaemia (12.5 mg/dL, reference range 8-10.7 mg/dL) and acute renal failure. On physical examination, the patient was found to have a solid mass behind his left ear ( figure 1A). Histopathological examination disclosed squamous cell carcinoma with areas of necrosis. Serum phosphorus level was low (2 mg/ dL, reference range 2.7-4.5 mg/dL) and intact parathyroid hormone (iPTH) was also low (4.4 pg/mL, reference range 10-65pg/mL), whereas an elevated PTH-related peptide (PTH-rP) level was found (27 pg/mL, reference range 14-25pg/mL). Bone scan disclosed focal uptake in bilateral parietal skull highly suspicious of bone metastases (figure 1B), further assessed with brain MRI (figure 2). Acute renal failure and hypercalcaemia improved with intravenous fluids without need for bisphosphonate administration. No evidence of other primary solid malignancy was found on CT of the chest and abdomen/pelvis. Workup for multiple myeloma was negative. The patient's tumour was deemed inoperable, and not amenable to systemic chemotherapy due to poor performance status; therefore, palliative radiotherapy was initiated. Learning points▸ Distant osseous metastases from cutaneous squamous cell carcinoma are rare and the underlying humoral mechanism involves parathyroid hormone-related peptide overproduction by the tumour. 1 Intriguingly, low but detectable serum intact parathyroid hormone levels are also involved in the development of humoral hypercalcaemia of malignancy.

Paraneoplastic Syndromes in Patients with Keratinocyte Skin Cancer

“…By evaluating the title/abstract information of the initially returned 831 papers we localized 53 articles with potentially relevant content for full-text search ( Figure 1 ). Of them, 15 were excluded (one was a duplicate publication, seven were cases of penile SCC, six were erroneously identified as reporting PNS in KSC and one reported no adequately personalized data) leaving to 39 papers reporting a total of 44 PNS cases associated with KSC [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. One paper ([ 47 ]) referred to five cases with relevant findings, however without any personalized data, and was excluded from this compilation, resulting in 38 papers reporting 39 relevant cases.…”