title: Case report: Upper arm metastasis of an oral squamous cell carcinoma.
abstract: BACKGROUND
  The Oral Squamous Cell Carcinoma (OSCC) frequently metastasizes lymphogenously. Haematogenous dissemination is less common. This report describes a rare case of a metastatic OSCC of the floor of the mouth to the patients' left upper arm. To our knowledge this is the first of such case described in the literature.
  
  
  METHODS
  Twelve months after R0 tumor resection surgery, including microvascular reconstruction of the lower jaw followed by adjuvant radiotherapy, the patient was admitted for osteosynthesis plates removal. During clinical examination a tumor located at his left upper arm was detected. According to the patient the tumor has demonstrated rapid growth. Macroscopic appearance and conventional imaging led to the differential diagnosis of an abscess. MR-imaging could not differentiate between a tumor of soft tissue origin and a metastasis. A biopsy was taken and the pathological examination confirmed the diagnosis of an OSCC metastasis. The postoperative interdisciplinary tumor board recommended radiation therapy.
  
  
  CONCLUSIONS
  Due to the fact that patients with regional lymph node metastases have a higher probability to develop distant metastasis a more detailed screening might be considered--especially when hemangiosis carcinomatosa was histologically or macroscopically found.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Matthias.Wurm@uk-erlangen.de.
authors.forename: Matthias Christian
authors.initials: MC
authors.lastname: Wurm
authors.affiliation: Department of Oral and Maxillofacial Plastic Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany. Emeka.Nkenke.extern@uk-erlangen.de.
authors.forename: Emeka
authors.initials: E
authors.lastname: Nkenke
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Friedrich.Neukam@uk-erlangen.de.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Neukam
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Tobias.Moest@uk-erlangen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Möst
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Rainer.Lutz@uk-erlangen.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Lutz
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Falk.Wehrhan@uk-erlangen.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Wehrhan
authors.affiliation: Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany. Kathrin.Brunner@uk-erlangen.de.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Brunner
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Konstantinos.Mitsimponas@uk-erlangen.de.
authors.forename: Konstantinos Theodorou
authors.initials: KT
authors.lastname: Mitsimponas
authors.affiliation: Department of Radiology, University of Erlangen-Nürnberg, Erlangen, Germany. Philipp.Schlechtweg@uk-erlangen.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schlechtweg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany. Cornelius.Wilmowsky@uk-erlangen.de.
authors.forename: Cornelius
authors.initials: C
authors.lastname: von Wilmowsky
mesh_terms: D000038:Abscess / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009060:Mouth Floor / Q000473:pathology* / Q000601:surgery; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D018714:Radiotherapy, Adjuvant / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012874:Skin Diseases, Infectious / Q000175:diagnosis; D012983:Soft Tissue Neoplasms / Q000556:secondary*; D034941:Upper Extremity / Q000473:pathology*