Refractory Hypercalcemia of Malignancy in Squamous Cell Carcinoma of the Buccal Mucosa With Skeletal Muscle Metastasis

Refractory hypercalcemia of malignancy (RHOM) is a challenging and often life-threatening condition characterized by persistently high serum calcium levels despite standard treatments. It is commonly associated with malignancies such as squamous cell carcinoma (SCC) of the lung, breast cancer, and multiple myeloma. However, studies on head and neck cancers, including SCC of the oral cavity, suggest that hypercalcemia can occur but is relatively rare. We report a case of a 45-year-old male with SCC of the buccal mucosa who presented with severe, refractory hypercalcemia. Despite aggressive hydration, bisphosphonates, calcitonin therapy, and glucocorticoids, serum calcium levels remained elevated. The patient was subsequently treated with hemodialysis, but despite this intervention, his clinical status did not improve, ultimately leading to his mortality. This case highlights the challenges in managing RHOM and underscores the need for better therapeutic strategies. Timely recognition and innovative treatment approaches are crucial for improving patient outcomes in refractory cases of hypercalcemia of malignancy.