SKIN METASTASIS FROM BASE OF TONGUE CARCINOMA AT PRESENTATION - A RARE CASE REPORT

Traditionally considered to be a loco-regional disease, head neck cancers metastasize infrequently to distant sites. Among these, skin metastases have been rarely reported and almost always they have been encountered during or after treatment of primary. We present here a case of squamous cell carcinoma of base of tongue with multiple dermal metastases at initial presentation. This report signifies that rarity of such cases must not delay the confirmation of diagnosis since these patients already carry a dismal prognosis. only a month back. Other than a history of heavy smoking for the last 30 years, there were no other forms of addiction. He was neither diabetic, nor hypertensive and had a ECOG performance of '2'. Clinical examination and contrast enhanced CT scan of neck revealed irregular hard mass in base of tongue eroding into left retromolar trigone and hard bilateral neck nodes with the largest one measuring 5.4X 6.2cm.A specimen from the tongue mass showed grade 2(moderately differentiated) squamous cell carcinoma with peri-neural invasion but no lympho-vascular tumor emboli was detected. Punch Biopsy from a skin nodule revealed metastatic squamous cell carcinoma deposits. Metastatic work-up revealed no other sites of metastasis. Routine investigations were essentially normal. The disease was staged to be cT4aN3M1. Salvage chemotherapy with Docetaxel (80mg/m2 on day 1), cisplatin (75mg/m2 on day 1) and 5-Flurouracil (1000mg/m2 day1-4) was initiated within a week and he has tolerated well two such cycles so far. A partial response of the primary and neck nodes has been documented and the skin nodules have completely disappeared (figure 2).