Unusual Skin Metastasis from Squamous Cell Carcinoma of the Oesophagus

Abstract

Cutaneous metastases from internal malignancies are very common. This report describes an extremely rare case of cutaneous metastases from esophageal carcinoma. This is a case of an uncommon cutaneous metastases from squamous cell carcinoma (SCC) of the esophagus in a 62-yearold female. This report emphasizes the importance that newly appearing skin lesions may be the first presentation of metastasis from esophageal carcinoma.A 62 yr old female admitted with h/o dysphagia to solids since three months. Upper GI endoscopy showed polypoid growth in mid esophagus at 30 cm beyond which scope could not be negotiated. Biopsy was taken and reported as moderately differentiated squamous cell carcinoma.After confirming operability and resectability transhiatal esophagectomy was performed in March 2008. Histopathological report showed moderately differentiated squamous cell carcinoma, extending up to the muscularis layer with lymphovascular metastasis, and nine out of thirteen nodes showed evidence of metastasis, however resection margins were free.Postoperative period was uneventful with no evidence of leak and the patient was able to eat solids. In view of R0 resection and HPE diagnosis of squamous cell carcinoma, the patient was not subjected to any form of adjuvant treatment.Patient followed up in August 2008 when she complained of a swelling on the left side of the chest wall.On examination, a 2 cm x 1 cm hard, nontender nodule, with no increase in local temperature, fixed to the skin but not to chest wall or ribs was palpated. There was no evidence of ulceration or discharge from the nodule. FNAC of the nodule was reported as metastatic squamous cell carcinoma.In September 2008, PET CT scan revealed active mediastinal, abdominal and retroperitoneal nodal disease. Bilateral pleural disease and pulmonary nodules in the right lung were also present.The patient was started on palliative chemotherapy with Taxol and Carboplatin. Four cycles were completed in December 2008. As there was no response to this treatment, the patient was then started on chemotherapy with Capecitabine plus Oxaliplatin, which again did not show any response. She was counseled and discharged on supportive treatment.

Locally Advanced Carcinoma Esophagus with Right Nipple Metastasis

“…Patients may present with distant metastasis much earlier than they develop local recurrence in form of dysphagia/weight loss. A complete history, careful physical examination, and radiology studies (CT scans, bone scans, positron-emission tomography) are essential in assessment of distant failures which suggests poor prognosis [9].…”

Unusual metastasis of esophageal cancer

“…In total of 4,000 cases of metastatic esophageal carcinoma skin metastases were found in about 10% of patients 7 . Maheshwari et al 10 report a case of a female patient with skin lesions and difficulties in swallowing. Similar to our case, Nisi et al 8 report a case of esophageal carcinoma with upper lip metastases.…”