Dermatology Online Journal

Grouped skin metastases from laryngeal squamous cell carcinoma and overview of similar cases
Sadollah Shamsadini MD¹, Aliakbar Taheri MD², Shahriar Dabiri³, Kerman Farshid Darvish Damavandi¹, and Siamak Salahi²
Dermatology Online Journal 9(5): 27

Departments of Dermatology¹, Otolaryngology², and Pathology³, Kerman University of Medical Sciences, Kerman, Iran. shamsadini@yahoo.com

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Abstract

Cutaneous metastases from internal malignancies or primary skin cancers are uncommon, particularly in a grouped pattern. We report a 58-year-old man with a known case of laryngeal squamous cell carcinoma who underwent radiotherapy after surgical excision of the tumor. Unilateral, grouped, red-brown, vesicle-like nodules appeared on his shoulder 9 months after the laryngeal surgery. The pathologic diagnosis of an excised nodule was metastatic squamous cell carcinoma.

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Introduction

In a review of 4,020 patients with metastatic squamous-cell carcinoma (SCC), cutaneous lesions occurred in 10.4 percent [1]. The morphology of these metastases include nodules, ulcers, inflammatory areas, sclerotic areas, bullae, and vesicles [2]. Carcinoma encuirasse, metastases presenting as alopecia, and grouped or zosteriform metastases are additional and uncommon presentations. A literature review found eight cases of grouped zosteriform skin metastases from various primary sites, but none from the larynx [3, 4, 5, 6, 7]. In general, skin metastases of SCC to the head and neck are rare [8]. In a recent description of 2,491 patients with SCC of the upper aerodigestive tract, only 19 (0.763 %) developed skin metastases [8]. As expected, this was a poor prognostic sign; 90 percent of these patients died within a median time of 3 months. We describe a patient with laryngeal SCC who developed grouped vesicle-like metastases on the left shoulder following radiotherapy.

Figure 1	Figure 1a
Grouped erythematous and vesicle-like nodules

Figure 1b	Figure 2
Grouped nodules on left shoulder(fig. 1b). Low-power histologic view of metastatic SCC (fig. 2).

Figure 3
Metastatic squamous cell carcinoma.

Clinical summary

A 58-year-old man with squamous cell carcinoma of the larynx is presented. He had a 20-year history of cigarette smoking and a history of heroin and opium addiction. Laryngeal SCC was diagnosed, and the patient underwent total laryngectomy followed by radiotherapy. Shortly after the radiotherapy and 1 year following surgery, a group of red-violet vesicle-like nodules appeared on his left shoulder. An attempt to aspirate fluid from a shiny, translucent lesion disclosed that it was actually a nodule (figs. 1, 2). A representative lesion on the right shoulder was excised, and the histology revealed a solid tumor with infiltration into the mid-dermis, islands of atypical squamous cells, and a few squamous eddies (fig. 3); these findings were consistent with the diagnosis of a nodular SCC metastasis. Additional radiotherapy was recommended.

Discussion

The clinical appearance of cutaneous metastases varies over a wide morphologic spectrum. Malignant melanoma has a high frequency of metastasis to the skin; skin metastasis from lung and kidney malignancies are less common [9]. In 1998 Cuq-Viguier et al. reported a case with a similar configuration of grouped vesicle-like skin metastases originating from SCC of the stump of an amputated arm [4]. Kato et al. in 2001 reported a case of zosteriform, epidermotropic metastases from primary skin SCC [3]. The cause of a grouped or dermatomal metastatic distribution in malignant lesions is not known, but perineural lymphatic invasion and spread has been hypothesized as a possible explanation for this pattern [10, 11, 12]. Tumor invasion of dorsal root ganglia with peripheral extension may have an important role [13]. Grouped and zosteriform metastases are uncommon but may result from neoplasms of many primary sites. In addition, the upper aerodigestive tract is a rare primary source for cutaneous SCC metastases. Our case demonstrates the unusual combination of grouped cutaneous metastases from a primary laryngeal SCC.

References

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3. Kato N,Aoyagi S,Sugawara H,Mayuzumi M.Zosteriform and epidermotropic primary cutaneous squamous cell carcinoma.Am J Dermatopathol Jun 23[3]:216-20 2001

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8. Pitman KT, Johnson JT. Skin metastases from head and neck squamous cell carcinoma: incidence and impact. Head Neck 1999;21:560-5.

9. Matarasso SL, Rosen T: Zosteriform metastasis:case presentation and review of the literature. J Dermatol Surg Oncol 14: 77-8, 1988.

10. Bluefarb SM, Wallk S, Gecth M: Carcinoma of the prostate with zosteriform cutaneous lesions. Arch Dermatol 76:402-6,1957.

11. Hodge SJ, Mackle S, Owen LG: Zosteriform inflammatory metastatic carinoma. Int Dermatol 18: 142-5, 1979.

12. Shamsadini S Dabiri S Zosteriform metastases in a man with malignant melanoma: Medical journal of the Islamic republic of Iran vol 16 Num 2 August 2002 pp115-17.

13. Jaworsky C, Bergfeld WF: Metastatic transition cell carcinoma mimicking zoster sine herpete. Arch Dermatol 122: 1357-8,1986.

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