Suspected Pulmonary Metastasis of Actinic Cutaneous Squamous Cell Carcinoma

Abstract EN

Introduction.

It is rare for actinic or squamous cell carcinoma (SCC) in situ to metastasize.

Case Presentation.

A 67-year-old male had a significant medical history including severe psoriatic arthritis treated with UVB, methotrexate, and rapamycin.

He had twenty-five different skin excisions of actinic keratosis four of which were invasive SCC.

Our patient developed shortness of breath necessitating a visit to the emergency department.

A CT scan of his chest revealed a mass in the right lower lung.

A subsequent biopsy of the mass revealed well-differentiated SCC.

He underwent thoracoscopic surgery with wedge resection of the lung lesion.

Discussion.

Actinic keratosis (AK) is considered precancerous and associated with UV exposure.

It exists as a continuum of progression with low potential for malignancy.

The majority of invasive SCCs are associated with malignant progression of AK, but only 5–10% of AKs will progress to malignant potential.

Conclusion.

In this case, a new finding of lung SCC in the setting of multiple invasive actinic cutaneous SCC associated with a history of extensive UV light exposure and immunosuppression supports a metastatic explanation for lung cancer.