Squamous cell carcinoma presenting as multiple discharging sinuses on the chin

Abstract

Squamous cell carcinoma (SCC) usually presents as a raised, firm, pink to skin-coloured keratotic papule, plaque or ulcer, arising on sun-exposed skin. We report an unusual case of a 65-year-old male patient who presented with a 1-year history of multiple discharging sinuses on his chin, which on investigation was found to be an SCC. A malignancy should be considered in the differential diagnoses of patients presenting with multiple discharging sinuses on the chin. We discuss other possible diagnoses for sinuses presenting on the face.

Oral Squamous Cell Carcinoma Mimicking Cervico-Facial Actinomycosis

“…The differentials needed to be considered here are actinomycosis, scrofuloderma, mycetoma, and invasive Letter to the Editor aspergillosis. 4,6 Indeed, actinomycosis formed a very close differential in our case because of history of dental extraction and clinical absence of lymphadenopathy. These were excluded by relevant microbiological investigations, histopathology, and imaging.…”

“…There are isolated case reports of other malignancies like sarcomatoid SCC, thyroid carcinoma, melanoma, and non-Hodgkins lymphoma presenting in similar way. 4 In our case, delay in diagnosis was not only due to the poor awareness but also due to the atypical clinical presentation of SCC as "wolf in the sheep's skin." This write-up portends to exemplify the importance of having high index of suspicion and to carry out simple histopathological examination at times of nonhealing of lesion to prevent delay in diagnosis and its subsequent poor prognosis.…”

“…There are isolated case reports of other malignancies like sarcomatoid SCC, thyroid carcinoma, melanoma, and non-Hodgkins lymphoma presenting in similar way. 4…”

“…3 Squamous cell carcinoma presenting as multiple discharging sinuses mimicking cerfico-facial actinomycosis, as in our case, is very rare. Literature review showed only two previous reports of such presentation 4,5 ( Table 1). Such uncommon presentations always cause diagnostic dilemma even to the most trained physician.…”