Abstract

Introduction: Squamous cell carcinoma is a common malignancy of skin with several other potential primaries. Metastatic squamous cell carcinoma typically involves regional lymph nodes. Cutaneous squamous cell carcinoma accounts for up to 20% of non-melanoma skin cancers. Common risk factors are age, UV exposure and phenotypic variations.

Case presentation: A 72-year-old female presented with left axilla swelling for 1 month. Clinically, noted left axillary lymphadenopathy measuring 4 x 3 cm. An urgent mammogram showed suspicious left subareolar lesion. The patient underwent wide local excision of breast, showing fibrocystic change while left axillary lymph nodes excision biopsy showing metastatic poorly differentiated carcinoma. While she was being worked out for primary malignancy site, she presented with a small exophytic growth lesion over left thumb. Subsequently, the patient was subjected to excision biopsy of the left thumb lesion and left axillary clearance. Histopathology examination found squamous cell carcinoma, poorly differentiated, with clear margins, while the left axillary lymph nodes showed metastatic squamous cell carcinoma. The patient was referred to the oncology team. 6 months later, she presented again with left axillary swelling. Clinically, there was a 10 x 8cm left axilla swelling involving matted lymph nodes. A CT scan showed multiple matted left axillary lymph nodes. The patient was scheduled for repeated axillary clearances with the option of a Limberg flap procedure. However, successful axillary clearance was performed without needing any flap. Intra-op, an area of matted axillary nodes measuring 12 x 9 cm, encasing the thoracodorsal vascular bundle was found. Histopathology examination is still pending.

Conclusion: Recurrent nodal metastases from squamous cell carcinoma is a challenging entity in terms of diagnosis and its management. The best outcome is achievable with surgery and adjuvant radiotherapy. The main aim is to achieve significant improvement in locoregional control. Proper follow up is mandatory to detect any relapse of the condition, although most cases are incurable.

Additional Information

This presentation was given at the SES 2020 online conference, 4 July 2020.