Sporotrichoid metastases to the skin from cutaneous squamous cell carcinoma in an immunocompetent patient

Squamous cell carcinoma (SCC) of the skin may metastasize in more than 5% of cases. Metastases usually involve the primary regional lymph nodes in 85% of cases. The skin is rarely involved by metastases of SCC of the skin. The presence of multiple cutaneous metastases in a figurate array is a very rare occurrence, mostly reported in SCC occurring in immunocompromized patients. The case of a 70-year-old immunocompetent patient, with an ulcerated primary SCC on his right palm and 3 nodules in a linear array on his right arm is described. He also presented with homolateral axillary lymphadenopathy. Histopathologic examination from the 3 nodules revealed SCC of variable grading, with focal fusion of the metastases with the overlying epidermis. The patient had been previously treated with chemotherapy and radiotherapy in another Department, with no benefit. Despite right arm amputation and homolateral axillary lymphadenectomy, the patient died 4 months after a procedure, for pulmonary embolism.