AB 52. Metastatic formation of scalp as a first symptom in a patient with squamous cell lung cancer

Background: The incidence of cutaneous metastases from cancer regardless of primary tumor varies from 0.7% to 10% with frequent localization in the head, neck and trunk. Frequent primary tumor is considered for male patients lung cancer - ranking in descending order of adenoCa, squamous, SCLC and Ca undetermined type - and incidence rate of 2.8% to 7.5%, and for women breast cancer.

Patients and methods: Male, 58 years old, smoker of 60 p/y referred by surgeon because of a two months worsening of dyspnea, without any other symptoms of the respiratory system (baseline because of gradually increasing size of the formations of scalp and neck, which underwent head and neck CT scan). The XR and the subsequent CT chest scan revealed a large mass of the right hilum with attendant node of the left lower lobe and enlargement of the mediastinal lymph nodes.

Results: The endoscopic image showed an exophytic necrotizing formation fully occluding the left stem bronchus. Obtained biopsies revealed squamous cell lung cancer, poorly differentiated, and respectively the FNAC\biopsy of formation of the scalp. The staging of the patient reveals osteolytic lesions in skull and spine, and secondary focus in left adrenal gland. The patient is subjected to a combination of chemotherapy and radiotherapy.

Conclusions: Skin metastases from lung cancer is a relatively rare event in the natural course of the disease, of the order of 2.8% to 7.5%, in particular to adenoCa and rarely in squamous histological type. The chest and the abdominal wall is the most common location (due to surface and proximity to the initial primary lesion). The prognosis for metastatic foci of skin is poor, responds poorly to chemotherapy, while the cutaneous lesions do not respond adequately, due to reduced blood supply of the skin.

In conclusion, cutaneous metastases are rarely the first manifestation of lung cancer and any appearance of cutaneous lesions in a particularly male smoker should raise the suspicion of investigation of potential malignancy of the lung.