Widespread subcutaneous distant metastases from a head and neck squamous cell carcinoma

Abstract

During the past 30 years, the incidence of squamous cell carcinoma (SCC) arising in the upper aerodigestive tract has generally increased worldwide.1 The development of SCC within the head and neck (HN) results from a series of genetic transformations producing a malignant phenotype.2 The essential nature of this malignant phenotype is its ability to act autonomously, initially invading local tissues and subsequently being capable of metastasizing to regional and distant sites. The cervical lymph nodes are the most common sites for regional metastases of oral and oropharyngeal SCC.3 The distribution of regional nodal deposits of metastatic SCC from various mucosal primary sites within the HN has been well documented in the literature.4,5 Distant metastases from primary cancers of the HN occur most commonly in the lungs, liver, and bone (Table 1). Other less common sites have been reported in the literature (Table 2). Historically the incidence of distant metastases (DMs) among patients with HN cancer has been very low. However, as local and regional control has improved, DMs may be seen as an increasingly important source of morbidity and mortality. There is a paucity of antemortem case reports of DM in the literature and none documenting subcutaneous deposits below the clavicles. In view of this, we report an unusual presentation of DM relating to widespread subcutaneous metastatic deposits. We also review the literature related to the presentation of DM arising from upper aerodigestive tract SCC.