Skin Metastases from Noncutaneous Head and Neck Cancers

Abstract

Objective: Investigate the distribution of spread, histopathologic characteristics, and prognostic implications of skin metastases arising from primary cancers of the head and neck. We present a case series of patients with skin metastases from non-cutaneous malignancies of the head and neck and perform a complete literature review on this topic. Method: Patients with skin metastases arising from noncutaneous cancers of the head and neck were identified by a dermatopathologist and cases were reviewed. A comprehensive literature search was performed and appropriate articles were selected and analyzed for relevant cases. Results: Twelve patients with skin metastases from noncutaneous carcinomas of the head and neck were identified. The most common primary site, histology, and location of spread was the parotid gland (33%), squamous cell carcinoma (42%), and scalp (25%), respectively. A literature search yielded 97 cases of dermal metastases from head and neck malignancies since 1972. Oral cavity was the most frequent site of origin, but many cases involved direct tumor extension rather than true metastatic spread. Skin metastases typically presented as a discrete nodule within the scalp, but morphology and distribution varied. Overall prognosis is poor with long-term survivors occasionally reported. Conclusion: Skin metastases are clinically rare, occurring in less than 1% of head and neck cancers, and when present typically herald a poor overall prognosis. Information regarding their distribution and clinical presentation is of particular importance to the otolaryngologist and oncologist in identifying, counseling, and treating patients diagnosed with skin metastases.