Cutaneous Metastasis of Squamous Cell Carcinoma of the Tongue as Bilateral Neck Nodules: A Case Report

Squamous Cell Carcinoma (SCC) of the oral cavity is one of the most common malignancies in the head and neck region. Although lymphatic spread is the most common mode of metastasis, it can also metastasise via the haematogenous route to internal organs such as the lungs, liver and bones. While cutaneous metastasis has been reported in SCC of the oral cavity, metastasis presenting as subcutaneous nodules on both sides of the neck is extremely uncommon. Hereby, authors present a 66-year-old male with a history of smoking and diabetes, diagnosed with well-differentiated SCC of the tongue. He underwent wide local excision, selective neck dissection and adjuvant radiation therapy. He developed a recurrence in the level V cervical lymph nodes after one year, which was surgically excised. Histopathology confirmed metastasis in all the nodes, with two showing extranodal extension. A few weeks later, patient presented with painful, umbilicated skin nodules on both sides of the neck. A biopsy confirmed these as cutaneous metastasis from SCC. This case details a unique presentation of SCC of the tongue, which relapsed as painful subcutaneous nodules on both sides of the neck, highlighting the varied clinical presentation, diagnostic approach and pathological findings.