Cutaneous metastases from cervical squamous cell carcinoma in a 55 year-old woman: a rarely reported manifestation

Abstract

Squamous cell carcinoma of the cervix was once the most common gynecologic cancer in the world, accounting for significant morbidity and mortality. With the advent of routine Papanicolaou screening in the United States during the latter half of the twentieth century, cervical cancer now accounts for a much smaller proportion of cancer deaths. Despite the advances that have been made in screening and early detection, women of low socio-economic status and immigrants from other countries who may not have access to health care continue to present with high-stage disease. Manifestations of advanced disease include direct invasion of structures adjacent to the cervix and distant metastases to the lung, bone, and liver. In approximately 0.5-1 percent of cases, metastases to the skin and soft tissue occur, most commonly to the abdominal wall and vulva, followed less frequently by the perineum and extremities. This particular manifestation has come to be regarded as a sign of terminal disease, with most patients surviving 3-6 months despite chemotherapy. Clinically, this may not be a diagnosis that is anticipated by the pathologist examining the biopsy. We present the case of a 55 year-old woman with a history of untreated squamous cell carcinoma of the cervix who presented with rapidly spreading, painful erythematous papules of the vulva, lower anterior abdominal wall, and proximal lower extremities. This case highlights a rare presentation of metastatic squamous cell carcinoma of the cervix, and underscores the importance of obtaining adequate clinical history, investigating a wide range of diagnoses as part of the differential diagnosis, and distinguishing primary cutaneous squamous cell carcinoma from a metastasis.