Synchronous Axillary Intranodal SCC And Scalp SCC Case Report – Skip Nodal Metastasis Or Malignant Transformation Of An Intranodal Squamous Cyst?

Abstract BackgroundIsolated axillary SCC nodal metastasis from a head and neck primary is a highly unusual presentation. Different possibilities include that of a skipped nodal metastasis bypassing the cervical region, or an axillary SCC of a separate unknown primary (SCCUP), or even malignant transformation of a preexisting intranodal squamous cyst. To date, there has been no report of isolated SCC nodal metastases from a scalp primary and even rarer, a case of malignant transformation of an intranodal squamous cyst. Case presentationWe present a successful management of a synchronous axillary nodal SCC and scalp SCC through curative surgery in a 73-year-old gentleman with extensive psoriasis and a history of immunosuppression from methotrexate use.ConclusionWe reviewed the literature of this rare entity of an axillary SCCUP, discussed its optimal investigations and management, and the three distinct possible explanations for this unusual presentation.