Abstract:

Cervical cancer is the fourth most common cancer in women worldwide and 80% of cervical cancers are squamous cell carcinomas (SCCs). Over 90% of SCCs are HPV-associated. The incidence and mortality rates of cervical cancer have drastically decreased due to the introduction of the screening and vaccination programs. Currently, the majority of cases occur in developing countries. SCC of the cervix commonly metastasize to the pelvic lymph nodes and distant metastases are usually uncommon. Skin metastasis is extremely rare (0.1-2%) and predicts a poor prognosis. Herein, we report the first case to our knowledge of cervical cancer with skin metastases to the distal digits in the United States. A 62-year-old patient with stage IV cervical SCC, status post chemoradiation presented with three fungating, erythematous, and non-tender nodules on her left second finger, left second toe, and right inguinal fold. A biopsy of her finger lesion revealed atypical keratinocytes with large hyperchromatic nuclei and scant cytoplasm involving the full thickness of the epidermis and extending into the reticular dermis. P16 immunostain demonstrated intense and diffuse staining. Findings were consistent with metastatic cervical SCC and authorization for HPV studies were pending. Two weeks later, the patient presented with altered mental status. A brain MRI showed multiple brain lesions with involvement of the skull likely from metastatic disease. Whole brain radiation was initiated but the patient died after few days. Skin metastasis from cervical SCC is rare and portends a poor outcome. We present a rare case with digital metastases and intraepidermal involvement.

Financial Disclosure:
No current or relevant financial relationships exist.

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Jana Tarabay, MD