Sporotrichoid Metastases to the Skin From Cutaneous Squamous Cell Carcinoma in an Immunocompetent Patient

Abstract

Squamous cell carcinoma (SCC) of the skin may metastasize in more than 5% of cases. Metastases usually involve the primary regional lymph nodes in 85% of cases. The skin is rarely involved by metastases of SCC of the skin. The presence of multiple cutaneous metastases in a figurate array is a very rare occurrence, mostly reported in SCC occurring in immunocompromized patients. The case of a 70-year-old immunocompetent patient, with an ulcerated primary SCC on his right palm and 3 nodules in a linear array on his right arm is described. He also presented with homolateral axillary lymphadenopathy. Histopathologic examination from the 3 nodules revealed SCC of variable grading, with focal fusion of the metastases with the overlying epidermis. The patient had been previously treated with chemotherapy and radiotherapy in another Department, with no benefit. Despite right arm amputation and homolateral axillary lymphadenectomy, the patient died 4 months after a procedure, for pulmonary embolism.

Sporotrichoid Keratoacanthomas: Case Report and Review of Neoplasms Presenting in a Sporotrichoid Pattern

“…Three patients died despite treatment. The 70-year-old man with metastatic cutaneous squamous cell carcinoma had progressive malignant disease following his amputation; he died from a neoplastic lung embolism four months after diagnosis [ 13 ]. The 83-year-old man with metastatic cutaneous squamous cell carcinoma also had progressive malignant disease following amputation and systemic therapies; he also died after a thromboembolic event [ 14 ].…”

Sporotrichoid Bowen disease in an immunosuppressed Indian patient

“…It is also worth noting that all three previously reported cases of sporotrichoid squamous cell carcinoma had occurred in immunocompetent individuals, while multiple lesions are otherwise more commonly reported in the background of immunosuppression. 5 In our case, the co-occurrence of Bowen disease with well-differentiated renal cell carcinoma seems unrelated and merely a coincidence.…”

“…4 We were able to find ten reports of neoplastic lesions occurring in this pattern, with four of them being metastases (three from squamous cell carcinoma and one from melanoma). 5 The other neoplasms include keratoacanthoma, epithelioid sarcoma, Langerhans cell histiocytosis, lymphoma and peripheral nerve sheath tumor. A review of these reports showed no significant difference with respect to the anatomic site of involvement (equal for upper and lower limbs) or in survival with systemic or topical chemotherapy.…”

An unusual case of sporotrichoid nodules: Metastatic cutaneous squamous cell carcinoma

“…Metastatic spreading to the skin of cutaneous SCC is a rare event in immunocompetent patients [1]. The diagnosis of cutaneous metastasis is based on history, clinical, and pathological criteria.…”

“…In that case, the aggressive behavior of the tumor was likely related to the immunosuppression. In 2010, Ciocca et al [1] reported sporotrichoid metastases to the skin in an immunocompetent patient. Their patient, like ours, had no history of congenital or acquired immunosuppression.…”