A rare case of direct cervical skin involvement from metastatic cervical lymph node in carcinoma of oral cavity

Authors

  • M. Lakshmi Narayana Department of Otorhinolaryngology, PES Institute of medical sciences and research, Kuppam, Chittor District, Andhra Pradesh, India
  • V. Swetha Department of Otorhinolaryngology, PES Institute of medical sciences and research, Kuppam, Chittor District, Andhra Pradesh, India
  • B. N. Kumarguru Department of Pathology, PES Institute of medical sciences and research, Kuppam, Chittor District, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20190784

Keywords:

Neck, Lymphadenopathy, Metastasis

Abstract

Carcinoma of the oral cavity is becoming more prevalent in India owing to increased betel nut chewing, beedi smoking, consumption of hans, gutka and other tobacco products. In the tumor spread, first it metastasizes to cervical nodes and then to distant sites. We report a rare case of direct skin involvement from metastatic cervical lymphadenopathy.  A 60 years old lady came with the complaints of swelling on the left side of the neck since 3 years. She was a betel nut chewer since childhood. On examination, the swelling was tender, firm, fungating with erythema over the swelling. Oral cavity examination showed a 2×3 cm ulcerative growth in the left gingivobuccal sulcus with grade III trismus. CECT scan showed irregular heterogeneously enhancing necrotic mass of size 5.1×4.2×3.7 cm, in the submandibular region showing skin infiltration.  There was an irregular heterogeneously enhancing lesion in the left gingivobuccal sulcus. Biopsy from the growth showed features of well-differentiated squamous cell carcinoma. The patient underwent composite resection and left modified radical neck dissection with complete excision of the fungating tumor with tumor-free margins. The defect in the oral cavity and neck was closed with pectoralis major myocutaneous flap and deltopectoral flap. Histopathology showed pT2N3bM0 with stage IVb and patient was advised adjuvant chemo-radiation. In conclusion, cervical skin involvement from cervical metastasis is rare compared to facial skin involvement from the tumor. Patients with N3b nodal staging should be planned in a multidisciplinary setting for a better treatment outcome.

References

Emanuel H, Emanuel P. Cutaneous Metastasis of Head and Neck Malignancy. International J Head Neck Surg. 2015;6(2):57-63.

Prim MP, De Diego JI, Hardisson D, Madero R, Nistal M, Gavilan J. Extracapsular spread and desmoplastic pattern in neck lymph nodes: two prognostic factors of laryngeal cancer. Ann Otol Rhinol Laryngol. 1999;108:672–6.

Kmucha ST, Troxel JM. Dermal metastasis in epidermal carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1993;119:326–30.

Yoskovitch A, Hier MP, Okrainec A, Black MJ, Rochon L. Skin metastases in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg. 2001;124(3):248-52.

Pitman KT, Johnson JT. Skin metastases from head and neck squamous cell carcinoma: incidence and impact. Head Neck. 1999;21:560–5.

Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol. 1993;29 (2):228-36.

Dragan AD, Nixon IJ, Orabi AA, Manganaris A, Jeannon JP, Guerrero-Urbano MT, Simo R. Direct skin involvement of cervical lymph node metastasis from mucosal squamous cell carcinoma of the head and neck. J Laryngol Otol. 2013;127(2):181-6.

Stavrianos SD, Ragbir M, McLean NR, Kelly CG, Soames JV. Head and neck skin involvement by non-cutaneous head and neck cancers: free flap reconstruction. Eur J Surg Oncol. 2000;26:594–8.

Haddad RI, Shin DM. Recent advances in head and neck cancer. N Engl J Med. 2008;359:1143–54.

Cole RD, McGuirt WF. Prognostic significance of skin involvement from mucosal tumors of the head and neck. Arch Otolaryngol Head Neck Surg. 1995;121(11):1246-8.

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Published

2019-02-23

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Section

Case Reports