Cutaneous cervical metastasis from an esophageal adenocarcinoma mimicking a dental cervical cellulitis: A case report

Cutaneous metastases occur in 0.5 to 9% of all cancers. Esophageal cancer is one of the most aggressive cancers worldwide. Most cutaneous metastases from esophageal cancer were related to squamous cell carcinomas. Few cases have been described about cutaneous metastases related to esophageal adenocarcinomas. These metastases mostly affect patients over 60 years-old, and present as cutaneous asymptomatic nodules. A 69-year-old male presented with a painless and extensive left neck cutaneous induration and erythema. The lesion that was initially diagnosed as a dental cervical cellulitis by his dental practitioner. The patient was known since 2019 to suffer from a esophageal adenocarcinoma whose first treatment was surgery. The patient was currently under immunotherapy for a local recurrence. We firstly assessed the uncommon cervical cellulitis by carrying out an injected head and neck computed tomography (CT) scan which showed an unspecific skin, dermal and muscular infiltration of the left cervical region. The 18-FDG PET/CT demonstrated a suspicious fixation of the neck that was followed by a skin biopsy. The histological and immunohistochemical examination showed the metastatic adenocarcinomatous origin of the cervical skin lesion. The patient was upstaged to a stage IV of his esophageal cancer and started palliative chemotherapy. Special attention must be paid in case of diffuse cervical skin infiltrations, even in the presence of a dental infection, in patients with cancer, in order to perform the correct diagnosis.