Skin Metastases in Squamous Cell Carcinoma of the Head and Neck

Abstract

Metastasis to skin sites is an uncommon feature of SCCHN. SM may represent the first clinical evidence of impending loco-regional recurrence or distant metastasis. The development of SM is an ominous sign associated with an extremely poor prognosis, similar to the development of distant metastasis at more typical sites. Both the development of SM and survival of patients developing SM are independent of primary tumor stage. Current treatment options of SM are limited in their efficacy.

Direct skin involvement of cervical lymph node metastasis from mucosal squamous cell carcinoma of the head and neck

“…The medical literature is confounded by series that include patients with skin involvement due to either direct extension or iatrogenic implantation, in addition to true distant skin metastasis, which accounts for 0.8-1.3 per cent of patients with head and neck SCC. 1,3,7 Part of this confusion is due to the incompletely understood mechanism of skin involvement in head and neck SCC. 1 Several possible mechanisms of skin involvement have been reported: direct spread from the primary tumour; local spread via intradermal lymphatics (particularly following disruption of the normal lymphatic drainage system secondary to surgery, radiotherapy or chemoradiotherapy, with resultant skin implantation); haematogenous spread via the normal venous drainage pathway (mainly the internal jugular vein or via Batson's plexus from gastrointestinal and genitourinary tumours), or as a result of a neck dissection causing bypass of the pulmonary circulation filtration function; 2,3 and finally, direct, extracapsular spread from metastatic lymph nodes.…”

“…1,3,7 Part of this confusion is due to the incompletely understood mechanism of skin involvement in head and neck SCC. 1 Several possible mechanisms of skin involvement have been reported: direct spread from the primary tumour; local spread via intradermal lymphatics (particularly following disruption of the normal lymphatic drainage system secondary to surgery, radiotherapy or chemoradiotherapy, with resultant skin implantation); haematogenous spread via the normal venous drainage pathway (mainly the internal jugular vein or via Batson's plexus from gastrointestinal and genitourinary tumours), or as a result of a neck dissection causing bypass of the pulmonary circulation filtration function; 2,3 and finally, direct, extracapsular spread from metastatic lymph nodes. The latter is however a very rare form of macroscopic extracapsular spread: the prevalence of extracapsular spread from pathologically positive nodes can be as high as 46 per cent, while the prevalence of direct skin involvement due to such extracapsular spread is less than 0.5 per cent.…”

“…Skin involvement in head and neck SCC patients can develop due to direct invasion from the index tumour, or can arise from metastatic lymphadenopathy or from metastatic nodular skin deposits secondary to haematogenous spread. [1][2][3] There appears to be some controversy over the distinction between true skin metastasis and other categories of skin involvement, and the differentiation of these categories has not been adequately addressed. 3 According to our literature search, there has been no previous study investigating the clinical presentation, management and outcome of patients presenting with direct skin involvement of metastatic lymph nodes from mucosal head and neck SCC, occurring in the absence of invasion of other anatomical structures.…”

Metastatic hypopharyngeal and esophageal cancer to a percutaneous endoscopic gastrostomy site

“…However, PEG in patients with head and neck cancer or esophageal cancer has on rare occasions been associated with metastasis to the abdominal wall [2,3], with incidence as high as 1% [4]. Prognosis is extremely poor for such patients, with a mean 1-year survival rate of 0% [5]. With regard to the mechanisms of onset, cancer tissue attached to a tube manipulated by the pull method is believed to colonize the gastrostomy site [6].…”

Carcinoma Buccal Mucosa with Multiple Cutaneous Metastases

“…Skin metastasis has been reported to occur in 0.8-2.4% of the patients with squamous cell carcinoma of head and neck, and may remain unnoticed due to its rare occurrence. [2][3][4] Very few reports are available in the literature with cutaneous metastasis.…”