Skin metastasis in a previously irradiated field from squamous cell carcinoma of the cervix.

Metastasis to the skin is rare in cervical carcinoma, occurring in about 1.3% of patients. Most common sites of skin lesions are the abdominal wall and vulva, followed by the anterior chest wall. We present what appears to be the first case of cutaneous metastasis from cervical carcinoma in a previously irradiated field. 54 year-old Hispanic female diagnosed with Stage IIB squamous cell carcinoma of the cervix in October 2000 was treated with definitive radiation therapy consisting of external beam radiation to the whole pelvis followed by high dose radiation (HDR) brachytherapy and pelvic sidewall boosts completed in August 2001. She remained in remission until May 2002 when she developed left supraclavicular lymphadenopathy. Biopsies confirmed the presence of metastatic squamous cell carcinoma of cervical origin. She received 4000 cGy to the left supraclavicular region with 11 cycles of cisplatin completed in December 2002. During 2003, she underwent several cycles of multi-agent chemotherapy given in various intervals. In December 2003, she developed new left axillary lymphadenopathy (also an uncommon occurrence); biopsies confirmed the presence of metastatic squamous cell carcinoma of cervical origin. On physical exam, she was noted to have multiple pruritic papular lesions over her left supraclavicular area at the site of her previous biopsy in May 2002. She proceeded to receive an additional 2500 cGy to the previously treated left supraclavicular area and left axilla, followed by a boost of 1500 cGy to the left axilla completed February 2004. During her treatment, biopsies were performed on her skin lesions confirming the presence of metastatic squamous cell carcinoma of cervical origin. Skin metastases from cervical carcinoma are very rare. This appears to be the first case of skin metastases from cervical carcinoma in a previously irradiated field with simultaneous axillary metastases. Her previous radiation to the left supraclavicular area consisted of higher energy photons (18 MV), which spares the skin, penetrating deeper, thus offering little prophylaxis from cutaneous metastases. This is in contrast to lower energy electrons which confer much larger doses to the skin surface. Whether combination therapy with photons and electrons to areas of nodal metastases in cervical cancer can prevent subsequent cutaneous metastases is a subject deserving further study.

Join Y. Luh, MD, Tony Y. Eng, MD, Liana H. Proffer, MD, Kevin L. Hall, MD, and Bernard Karnath, MD. Department of Radiation Oncology, Department of Dermatology, Department of Obstetrics and Gynecology, Division of Oncology and Gynecology, and Department of Internal Medicine, University of Texas Health Science Center at San Antonio, University of Texas Medical Branch, San Antonio, TX.