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Extraordinarily aggressive cutaneous sarcomatoid squamous cell carcinoma of the face: a case report

  • Lee, Yunjae (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Lee, Dongkyu (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Yeo, Hyeonjung (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Park, Hannara (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Park, Hyochun (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital)
  • Received : 2022.01.24
  • Accepted : 2022.04.19
  • Published : 2022.04.20

Abstract

Sarcomatoid squamous cell carcinoma (SSCC), a biphasic malignant tumor consisting of atypical squamous epithelial and mesenchymal elements mixed with epithelioid and spindle cells, is a variant of squamous cell carcinoma. Cutaneous SSCC is very rare and aggressive and has a poor prognosis. Here, we report a case of cutaneous SSCC with satellites and in-transit metastases. A 79-year-old woman presented with a protruding mass on the left temporal area sized 1.2×1.0 cm. The punch biopsy report indicated keratoacanthoma or well-differentiated squamous cell carcinoma. The size of the tumor increased to 2.7×2.0 cm after 8 days. An excisional biopsy was performed with a 2 mm safety margin. The tumor was identified as SSCC with a clear resection margin. Reoperation was performed thrice with an increased safety margin of 10 mm; however, the cancer recurred along with satellites and in-transit metastases. Chemoradiotherapy was administered; however, the size of the tumor increased along with satellites and in-transit metastases. The patient expired 162 days after the initial excision. Complete excision and immediate multidisciplinary approach should be combined during the early stages due to the aggressiveness and poor prognosis of cutaneous SSCC with satellites and in-transit metastasis.

Keywords

References

  1. El Harroudi T, Ech-Charif S, Amrani M, Jalil A. Primary carcinosarcoma of the skin. J Hand Microsurg 2010;2:79-81. https://doi.org/10.1007/s12593-010-0013-8
  2. Thompson LD, Wieneke JA, Miettinen M, Heffner DK. Spindle cell (sarcomatoid) carcinomas of the larynx: a clinicopathologic study of 187 cases. Am J Surg Pathol 2002;26:153-70. https://doi.org/10.1097/00000478-200202000-00002
  3. Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2018. Sejong: Ministry of Health and Welfare; 2020.
  4. Lee ET. A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion. Arch Craniofac Surg 2020;21:58-63. https://doi.org/10.7181/acfs.2019.00654
  5. Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017;67:472-92. https://doi.org/10.3322/caac.21409
  6. Carucci JA, Martinez JC, Zeitouni NC, Christenson L, Coldiron B, Zweibel S, et al. In-transit metastasis from primary cutaneous squamous cell carcinoma in organ transplant recipients and nonimmunosuppressed patients: clinical characteristics, management, and outcome in a series of 21 patients. Dermatol Surg 2004;30(4 Pt 2):651-5. https://doi.org/10.1097/00042728-200404020-00013
  7. Ma JH, Wu A, Veness M, Estall V, Hong A, Borg M, et al. Intransit metastasis from squamous cell carcinoma. Dermatol Surg 2016;42:1285-92. https://doi.org/10.1097/DSS.0000000000000864
  8. Altunay I, Cerman AA, Sakiz D, Ates B. Marjolin's ulcer presenting with in-transit metastases: a case report and literature review. Ann Dermatol 2015;27:442-5. https://doi.org/10.5021/ad.2015.27.4.442
  9. Copcu E, Dikicioglu E, Sivrioglu N, Meteoglu I. Subcutaneous nodules on the face: acantholytic in-transit cutaneous metastasis. Dermatol Surg 2004;30:1415-9. https://doi.org/10.1111/j.1524-4725.2004.30438.x
  10. Viswanathan S, Rahman K, Pallavi S, Sachin J, Patil A, Chaturvedi P, et al. Sarcomatoid (spindle cell) carcinoma of the head and neck mucosal region: a clinicopathologic review of 103 cases from a tertiary referral cancer centre. Head Neck Pathol 2010;4:265-75. https://doi.org/10.1007/s12105-010-0204-4
  11. Berg JO, Tei TM. Primary cutaneous carcinosarcoma: review and presentation of a case with emphasis on clinical characteristics and management. Eur J Plast Surg 2005;28:99-104. https://doi.org/10.1007/s00238-005-0754-y
  12. Oktay M, Kokenek-Unal TD, Ocal B, Saylam G, Korkmaz MH, Alper M. Spindle cell carcinoma of the tongue: a rare tumor in an unusual location. Patholog Res Int 2011;2011:572381. https://doi.org/10.4061/2011/572381
  13. Krisanaprakornkit S, Iamaroon A. Epithelial-mesenchymal transition in oral squamous cell carcinoma. ISRN Oncol 2012;2012:681469. https://doi.org/10.5402/2012/681469
  14. Kim BJ, Kim HS, Chang YJ, Kwon KH, Cho SJ. Primary amelanotic melanoma of the mandibular gingiva. Arch Craniofac Surg 2020;21:132-6. https://doi.org/10.7181/acfs.2019.00633
  15. Oh SJ, Moon D. Spindle cell myoepithelioma of the parotid gland. Arch Craniofac Surg 2019;20:336-40. https://doi.org/10.7181/acfs.2018.02341
  16. Kaufmann O, Fietze E, Mengs J, Dietel M. Value of p63 and cytokeratin 5/6 as immunohistochemical markers for the differential diagnosis of poorly differentiated and undifferentiated carcinomas. Am J Clin Pathol 2001;116:823-30. https://doi.org/10.1309/21TW-2NDG-JRK4-PFJX
  17. Tran TA, Muller S, Chaudahri PJ, Carlson JA. Cutaneous carcinosarcoma: adnexal vs. epidermal types define high- and lowrisk tumors: results of a meta-analysis. J Cutan Pathol 2005;32:2-11. https://doi.org/10.1111/j.0303-6987.2005.00260.x
  18. Wie CE, Lee SH, Lim YS, Lee JC. A case of solitary sarcomatoid carcinoma of the neck. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:646-50. https://doi.org/10.3342/kjorl-hns.2012.55.10.646
  19. Hwang SO, Lee SH, Lee HB. Epithelioid sarcoma associated with neurofibromatosis type I. Arch Craniofac Surg 2020;21:41-4. https://doi.org/10.7181/acfs.2019.00640
  20. Testori A, Ribero S, Bataille V. Diagnosis and treatment of in-transit melanoma metastases. Eur J Surg Oncol 2017;43:544-60. https://doi.org/10.1016/j.ejso.2016.10.005