In-Transit Metastasis of Cutaneous Squamous Cell Carcinoma With Lymphovascular Invasion in an Immunocompetent Patient

Abstract

In-transit metastases of melanoma and non-melanoma skin cancers are metastases located in the skin or subcutaneous tissue between the primary tumor and the nearest nodal basin. Although rare, in-transit cutaneous squamous cell carcinoma (SCC) is an emerging diagnosis in immunocompromised and immunocompetent patients that may have significant implications on treatment and prognosis. Lymphovascular invasion is an uncommon high-risk feature of SCC. Here, we present a case of a 73-year-old non-immunosuppressed man with no previous history of skin cancer, found to have in-transit metastasis with lymphovascular invasion during Mohs surgery for a primary SCC of his right ear. Patients with in-transit SCC should receive further staging imaging and a multimodal approach to treatment, including Mohs micrographic surgery, adjuvant radiation, and possibly sentinel lymph node biopsy and immunotherapy or chemotherapy.

Metastatic patterns and treatment options for head and neck cutaneous squamous cell carcinoma (Review)

“…Currently, to the best of our knowledge, there are no indicators of metastasis in cSCC other than conventional histopathological examination. High-risk clinicopathological characteristics of cSCC metastasis include immunosuppression, poor histological differentiation, perineural invasion (PNI), lymphovascular invasion, tumor size >2 cm, depth of invasion >6 mm, and the main location being the scalp, ear or lip ( 10 ). Consensus is currently lacking on the definition for high-risk conditions or the ideal cSCC therapy.…”