Perineural spread of squamous cell carcinoma involving the spinal accessory nerve in an immunocompromised organ transplant recipient.
BACKGROUND
Squamous cell carcinoma is the second most common cutaneous malignancy in humans, affecting approximately 200,000 people in the United States each year. In immunocompromised patients, squamous cell carcinoma is the most common skin cancer, and it also tends to behave more aggressively than in immunocompetent patients.


OBJECTIVE
We describe an immunocompromised patient, previously treated for a squamous cell carcinoma of the left posterior shoulder, who subsequently developed a cord-like, intraneural metastasis of the spinal accessory nerve.


RESULTS
The patient presented with a 3-month history of lancinating pain of the left neck and shoulder. He had been treated previously for a squamous cell carcinoma of the left posterior shoulder, which subsequently recurred twice. On examination, a cord-like mass was palpable along the path of the spinal accessory nerve. Given the aggressive nature of this patient's squamous cell carcinoma, surgical exploration was performed. Frozen-section analysis of the spinal accessory nerve and of the multiple supraclavicular nerves revealed perineural and intraneural squamous cell carcinoma.


CONCLUSIONS
To our knowledge, this is the first reported case of a primary cutaneous squamous cell carcinoma of the trunk or extremity metastasizing to a cranial nerve.
Streams
Brian N
BN
Divisions of Mobs Surgery and Head and Neck Surgery, Scripps Clinic, La Jolla, California, USA. bstreams@hotmail.com
Eaton
Jeffrey S
JS
Zelac
Daniel E
DE
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D003937:Diagnosis, Differential; D005921:Glomerulonephritis; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012782:Shoulder; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery