Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 6, Num. 3, 2010, pp. 402-403

Journal of Cancer Research and Therapeutics, Vol. 6, No. 3, July-September, 2010, pp. 402-403

Letter to the Editor

Scalp metastasis from squamous cell carcinoma of the lung

Channappa Patil¹, Harish Permi²

¹ Department of Medical Oncology, Justice K S Hegde Medical Academy, Deralakatte, Mangalore, India
² Department of Medicine, Justice K S Hegde Medical Academy, Deralakatte, Mangalore, India

Correspondence Address:Channappa Patil, Department of Oncology, Justice K S Hegde Charitable Hospital, Deralakatte, Mangalore, India, drpats1@yahoo.co.in

Code Number: cr10103

PMID: 21119293

DOI: 10.4103/0973-1482.73331

Sir,

A 60-year-old male presented to the dermatology outpatient department with two painless nodules in the scalp. His physical examination was unremarkable except for the two firm swellings over the scalp and poor performance status [Figure - 1]. Fine needle aspiration cytology revealed atypical keratinized squamous cells arranged in clusters and singly. The cells were pleomorphic, having scanty to moderate amount of cytoplasm and enlarged hyperchromatic nucleus with coarse chromatin. Because the patient was a chronic smoker and performance status 3, a chest X-ray was performed. The chest X-ray showed a mass lesion with spiculated borders in the left mid zone. Computerized tomography of the chest revealed a mass in the left lower lobe close to the left bronchus and liver metastasis. Bronchoscopy and biopsy of the lesion confirmed squamous cell carcinoma of the lung [Figure - 2].

Cutaneous metastasis in primary lung cancer is unusual, with an incidence estimated at <5%. ^[1] The most common sites for skin metastasis in lung cancer are the chest and the abdominal wall. ^[2] This is presumably due to the high body surface area of these regions and also the closeness to the site of the primary neoplasm. Scalp metastasis, however, is unusual in primary lung cancer.

According to the case series published on lung cancer, ^[3] the more common histological types that metastasize to skin are large cell carcinoma and adenocarcinoma, while epidermoid or squamous cell carcinoma show the least tendency for skin metastasis. ^[2] Our case, however, was one of squamous cell carcinoma. As the patient was not fit for palliative chemotherapy, he was given the best supportive care. The patient expired 2 months after the diagnosis. Most studies indicate that the overall prognosis in patients with skin metastasis from primary lung cancer is poor, with median survival rates of <6 months. ^[4]

Physicians are likely to recognize a new skin lesion and skin biopsy or fine needle aspiration cytology should be performed from the lesions located even at uncommon sites. Squamous carcinoma of the lung is a rare source but should be considered if the patient is a chronic smoker and has poor performance status, as was seen in our case.

References

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