A clear case of postoperative metastasis to the toes from squamous cell carcinoma

Abstract

Background. Metastasis to the toe from lung cancer is very rare, occurring in only 0.1-0.3% of all lung cancer patients. Case. A 70-year-old man had a nodule in the left upper lung on chest X-ray obtained during his annual health checkup. Computed tomography revealed a mass, 32 mm in size, in the left S1＋2 that was diagnosed as squamous cell carcinoma (cT2aN0M0, Stage IB). Left upper lobectomy and S6 wedge resection with lymph node dissection (2a-1) were performed. The pathological diagnosis was keratinizing squamous cell carcinoma (pT2aN0M0-Stage IB) with interstitial pneumonia. We decided not to administer adjuvant chemotherapy because of interstitial pneumonia. About two months after surgery, the patients right 5th toe was badly swollen with severe pain. A skin biopsy suggested metastasis from the squamous cell lung cancer. His ultimate diagnosis was metastases of the lung cancer to the right hilar lymph node, left adrenal gland, and right 5th toe. Because the toe metastasis had increased rapidly, amputation of the 3rd to 5th toes was performed to his preserve quality of life. Thereafter, chemotherapy was administered to reduce the tumor metastases, but this failed to have a positive effect. Consequently, the patient underwent palliative therapies. Conclusion. Among metastases to the hands and feet, those from lung cancer are most frequent, and their prognosis is very poor. Because metastasis to the toe from squamous cell lung cancer is rare, we must distinguish between primary skin cancer and toe metastasis from lung cancer after careful consideration of the patients clinical symptoms.