Cutaneous Metastasis From Tonsillar Squamous Cell Carcinoma: Report and Review of the Literature

Abstract

Tonsillar squamous cell carcinoma, which represents 10% of head and neck malignancies, rarely manifests with cutaneous metastases; to date, only three prior patients with tonsillar squamous cell carcinoma have been reported to develop cutaneous metastases. We describe the clinical features of a 59-year-old man with squamous cell carcinoma of the tonsil who developed cutaneous metastases within his prior radiation port and review the literature of prior patients with cutaneous metastases from tonsillar squamous cell carcinoma. The PubMed database was searched for the following keywords: carcinoma, cutaneous, metastasis, squamous, and tonsil. The papers generated by the search and their references were reviewed. Cutaneous metastasis from tonsillar cancer is rare but should be considered in patients with a history of a squamous cell carcinoma of the tonsil; new skin lesions, both overlying the visceral malignancy and at more distant sites, should be biopsied since prognosis in these patients is poor. Management has thus far been palliative and should be individualized to the patient.

Cutaneous metastasis of tonsillar carcinoma: Report of a rare case

“… 2 To our knowledge, there are only 4 previously documented occurrences of CM from a tonsillar primary ( Table I ). 3 , 4 , 5 , 6…”

“…All 5 cases of tonsillar carcinoma occurred in men 40 to 70 years of age. 3 , 4 , 5 , 6 Three patients were chronic smokers, a significant risk factor for human papillomavirus (HPV) – tumors. 9 HPV infection has been implicated in the pathogenesis of oropharyngeal cancers and, according to a meta-analysis of data, has a prevalence of 48%.…”

“… 7 , 8 In 4 of the 5 cases, CM were the initial presenting sign of disease recurrence. 3 , 4 , 5 , 6 The time to presentation ranged widely from 6 to 54 months. 3 , 4 , 5 , 6 In a study by Yoskovitch et al, the time to presentation of CM in SCCHN averaged 17.65 months with 75% of cases appearing by 18 months.…”

“… 1 , 2 To date, only 4 prior cases have been described in the literature. 3 , 4 , 5 , 6 The diagnosis of tonsillar carcinoma CM may be unexpected, as clinical presentation varies widely, and cases can present after a disease-free interval. Dermatologists, therefore, are uniquely positioned to be the first to identify disease recurrence.…”

Monocle tumor as tonsillar squamous cell carcinoma metastasis: resolution after chemotherapy treatment

“…Regional node involvement is evident in approximately 30% of patients, and visceral metastases are infrequently observed, with lung being the most common site, followed by liver and bone . Cutaneous metastases are quite rare; only four patients have been reported to date . All these patients were males, aged between 40 and 70, and time to presentation varied from 6 to 54 months from tumor diagnosis.…”