Ann Dermatol.  2011 Feb;23(1):101-103. 10.5021/ad.2011.23.1.101.

A Case of Metastatic Squamous Cell Carcinoma Arising from Actinic Cheilitis

• Kwon NH
• Kim SY
• Kim GM

• KMID: 2171965
• DOI: http://doi.org/10.5021/ad.2011.23.1.101

Abstract

Actinic keratosis (AK) is a common, sun-induced, pre-malignant lesion with a strong likelihood of progressing to a malignancy. The reported risk of AK progressing to squamous cell carcinoma (SCC) varies from less than 1% to 20%. Clinically, induration, pain, large size, marked hyperkeratosis, ulceration, bleeding, rapid growth, and recurrence or persistence may be markers of AK progression into SCC. The risk of SCC metastasizing ranges between 0.5% and 3%. However, SCC of the lip arising from actinic cheilitis is more prone to metastasis than cutaneous SCC, with rates of the former varying between 3% and 20%. Here we report a typical case of SCC from actinic cheilitis with metastasis to the lymph nodes during a 4-year follow-up period. To exclude SCC, we emphasize the need for regular follow-up and prompt evaluation, including careful pathologic examination for actinic cheilitis.

Keyword

Actinic cheilitis; Squamous cell carcinoma

MeSH Terms

Actins
Carcinoma, Squamous Cell
Cheilitis
Follow-Up Studies
Hemorrhage
Keratosis, Actinic
Lip
Lymph Nodes
Neoplasm Metastasis
Recurrence
Ulcer
Actins
Cheilitis

Figure

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  Fig. 1 Clinical presentation of our patient. (A) Initial visit, (B) 30 months later, (C) after excision.

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  Fig. 2 Histology of our patient. (A) Chronic inflammatory cell infiltration in the dermis without epidermal change at the initial visit. (B) Atypical, pleomorphic keratinocytes are confined to the epidermis 30 months later. (C) Extension of atypical keratinocytes in the tumor nest beyond the basement membrane after excision. (D) Suggestive squamous cell carcinoma in the lymph node (A, B, C, D: H&E, ×40, ×400).

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  Fig. 3 (A) A whole body computed tomography showing increased signal intensity in the right submandibular area. (B) The positron emission tomography-computed tomography image shows increased fluorine-18-fluorodeoxyglucose (18F-FDG) uptake in the same area, suggestive of lymph node metastasis (arrow).

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