IDDF2019-ABS-0206 Carcinoma penis with unusual site of metastasis to liver and at tip of nose

Abstract

Background Carcinoma of the penis is an uncommon malignancy in Western countries, representing 0.4% of male malignancies, while in Asia, Africa, and South America 10% of all malignancies. The most common distant metastatic sites are the lung, bone, and liver. Local recurrence after a properly planned and executed partial or total penectomy is rare. However local recurrences may occur at the remaining shaft of the penis or at neomeatus or in subcutaneous nodules in nearby skin of groin after groin node dissection. However, recurrences in subcutaneous nodules at distant sites have not been seen in literature. We present here a case of carcinoma penis, treated with total penectomy and bilateral ilio-inguinal block dissection presenting with jaundice, the suggestion of liver metastasis and subcutaneous recurrence. Methods 60 years old, non-smoker male with no co-morbid conditions presented with a history of a small ulcer over penis for 3–4 months, underwent circumcision. He underwent total penectomy with bilateral ilio-inguinal block dissection. Biopsy & Histopathology was suggestive of moderately differentiated squamous cellcarcinom. Few inguinal and pelvic nodes were positive for metastasis. He was advised adjuvant treatment (radiotherapy) but defaulted for 3 months. Then he presented with multiple small nodules in left grow in region suggestive of recurrence. Palliative radiotherapy was started to inguinal region. During radiotherapy, a subcutaneous nodule developed over the tip of the nose. (figure 1) Biopsy from the nodule was positive for metastatic squamous cell carcinoma. Results Cases of cutaneous metastasis to penis have also been mentioned in literature from various organs like urothelial carcinomas, colorectal adenocarcinomas, pulmonary carcinomas, squamous cell carcinoma of the base tongue, cutaneous malignant melanoma and acute myeloid leukemia. A case of distant cutaneous metastasis from penis has not been mentioned in literature to the best of our knowledge. Conclusions This patient developed local recurrence in the form of subcutaneous groin nodule, liver metastasis and a distant metastatic subcutaneous nodule at the tip of the nose. This case is presented because of the unusual and rare presentation in the form of distant subcutaneous metastasis.