Aggressive parotid gland and neck  metastasis caused by cutaneous squamous  cell carcinoma of the scalp: A Case Report.

Pamela Curiqueo; Pablo Romero; Macarena Cea

doi:10.17126/joralres.2021.016

Pamela Curiqueo Servicio de salud Araucanía Norte, Hospital de Purén, Purén-Chile.
Pablo Romero Escuela de Odontología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
Macarena Cea Servicio de Salud Valdivia, CESFAM Mariquina, Mariquina-Chile. http://orcid.org/0000-0002-2913-9124

DOI: https://doi.org/10.17126/joralres.2021.016

Abstract

Introduction: The head and neck are frequent sites for the development of cutaneous cancer and squamous cell carcinoma of the skin (SCC), one of the more frequent malignant non-melanoma skin neoplasms in Chile (436 per 100,000 inhabitants). Between 5-10% skin SCC progresses aggressively generating metastasis to parotid and cervical lymph nodes. Case Report: A 82 years old male, presents painful increased volume lesion in the mandibular area. He has a history of chronic arterial hypertension, acute renal failure, SCC of the scalp, extra-pulmonary tuberculosis, chronic sun exposure and smoking. Extraoral examination showed a 4 cm lesion in the posterior third of the mandibular branch, with undefined edges, a firm consistency and painful on palpation. Intraorally, erythematous mucosa is observed, as well as lack of lubrication, tenderness and cortical bone expansion. Incisional biopsy is performed, imaging and histological exams are requested. The results indicate the presence of SCC, and therefore referral to secondary care. Many risk factors are associated with SCC development, with ultraviolet radiation the most relevant in this case, favoring its appearance on the scalp. The probability of metastasis is low, but when it happens, the majority of cases that started in the scalp, disseminate to the parotid and cervical region. Conclusion: The SCC has a good prognosis. However, there are antecedents, such as size and location, that must alert the professional to perform the monitoring, early screening, control of metastatic nodes in maxillofacial area.

References

[1]. O'Brien CJ, McNeil EB, McMahon JD, Pathak I, Lauer CS, Jackson MA. Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head Neck. 2002; 24(5):417-22.

[2]. Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol. 2018; 78(2): 237-247.

[3]. Muzic JG, Schmitt AR, Wright AC, Alniemi DT, Zubair AS, Lourido JM, et al. Incidence and trends of basal cell carcinoma and cutaneous squamous cell carcinoma: a population-based study in Olmsted County, Minnesota, 2000 to 2010. Mayo Clin Proc. 2017; 92(6):890-898.

[4]. Cognetta AB, Mendehall WM. Radiation Therapy for Skin Cancer. New York. Springer Science & Business Media; 2013.

[5]. Sipprell WH 3rd, Yu WY, Yu SS. Cranial neuropathies as the presenting symptom of cutaneous squamous cell carcinoma. JAAD Case Rep. 2019;5(12):1037-1040.

[6]. Del Charco JO, Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Mendenhall NP. Carcinoma of the skin metastatic to the parotid area lymph nodes. Head Neck. 1998; 20(5):369-373.

[7]. Franzen A, Lieder A, Buchali A. The rising incidence of parotid metastases: our experience from four decades of parotid gland surgery. Acta Otorhinolaryngol Ital. [Internet] 2017; 2017; 37(4): 264–269.

[8]. Franzen A, Lieder A, Guenzel T, Buchali A. The Heterogenicity of Parotid Gland Squamous Cell Carcinoma: A Study of 49 Patients. In Vivo. 2019; 33(6): 2001–2006.

[9]. Osterlind A, Hjalgrim H, Kulinsky B, Frentz G. Skin cancer as a cause of death in Denmark.Br J Dermatol. 1991; 125(6):580-2.

[10]. Czarnecki D. Non-melanoma skin cancer mortality rising in susceptible Australians. J Eur Acad Dermatol. 2017; 31(6):e286-e287.

[11]. Rappoport DW, Veloso MO, Montes RF, Pizarro GF, Valdés GF. Metastatic basal cell carcinoma. Rev. Otorrinolaringol. Cir Cabeza Cuello. 2016; 76: 347-52.

[12]. Sahovaler A, Krishnan RJ, David H. DH, Zhou Q, Palma D, Fung K, Yoo J, Nichols A, MacNeil SD. Outcomes of Cutaneous Squamous Cell Carcinoma in the Head and Neck Region With Regional Lymph Node Metastasis: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2019; 145(4): 352–60.

[13]. Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL. Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: a systematic review and meta-analysis. JAMA dermatol. 2016; 152(4):419-28.

[14]. Cheng G, Liu F, Niu X, Fang Q. Role of the pretreatment neutrophil-to-lymphocyte ratio in the survival of primary parotid cancer patients. Cancer Manag Res. 2019; 11: 2281–6.