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Abstract

patient was diagnosed with cutaneous SCC of the right hand dorsum and underwent surgical excision with split thickness skin graft in September 2006. In December 2007, he had a recurrence of SCC in a right axillary lymph node and underwent lymph node dissection. At that time, postoperative radiotherapy was considered, but was not performed because the patient was lost to follow up. In July 2008, the patient was referred to us because of a rapidly growing axillary mass with skin ulceration. Chest computed tomography (CT) showed a 7.6-cm cystic mass with inhomogeneous enhancement in the right axillary area (Fig. 1a). No visceral metastasis was detected. At a multidisciplinary review, we planned chemoradiotherapy followed by surgery to obtain complete resection and to preserve adjacent structures. The patient underwent external beam radiation (2 Gy/day, 5 days a week for a total dose of 50 Gy) and two 3-week courses of chemotherapy with cisplatin (15 mg/m 2 on days 1-5) and 5-fluorouracil (850 mg/m 2 on days 1-5). The treatment was delivered without serious side effects. Chest CT after the chemoradiation showed a partial tumour response with reduction of tumour size to 3.2 cm (Fig. 1b). Subsequently, the patient underwent complete surgical excision with pathologically clear resection margin.Recently, Fujisawa et al. reported two patients with locally advanced cutaneous SCC who were treated successfully with chemoradiation using cisplatin and 5-fluorouracil. 2 In addition, a case of distant lymph node metastasis managed successfully with the same chemoradiation protocol has been reported. 3 In our case, chemoradiation with cisplatin and 5-fluorouracil, which was based on Fujisawa's report, induced a partial tumour response, which enabled complete tumour resection, suggesting the possible role of chemoradiotherapy followed by surgical excision in the treatment of unresectable metastatic SCC of the skin. It is difficult to perform a prospective clinical trial of chemoradiotherapy followed by surgery in the treatment of metastatic cutaneous SCC because of its rarity, but this treatment constitutes a treatment option.