In-Transit Metastasis From Squamous Cell Carcinoma.
BACKGROUND
In-transit metastasis from cutaneous squamous cell carcinoma (SCC) is an uncommon form of metastasis through lymphatics and occurs more commonly in immunosuppressed patients.


OBJECTIVE
To identify cases of in-transit SCC and determine patient characteristics, tumor features, management, and prognosis.


METHODS
A multicenter case series treated by Australian and New Zealand clinicians.


RESULTS
In 31 patients, median age was 72 years (range 52-99) and 68% were immunocompetent. Tumors occurred on the head and neck in 94% of cases, with 71% of all tumors occurring on the scalp, forehead, or temple. The median time to presentation with in-transit SCC from treatment of the initial tumor was 5 months. Management included surgery (94%), radiotherapy (77%), chemotherapy (10%), and reduction of immunosuppression (3%). Median follow-up was 12 months. Overall survival at 3 and 5 years were 27% and 13%, respectively.


CONCLUSIONS
In-transit metastases are described in 31 patients, of whom the majority was immunocompetent. The scalp, forehead, and temple were the most common sites. New clinical and histological diagnostic criteria are proposed. Prognosis was poor with 5-year survival of 13%. Recommended management is a combination of surgery and adjuvant radiotherapy. Reduction of any iatrogenic immunosuppression should be considered.
*Department of Dermatology, Royal Adelaide Hospital, Adelaide, Australia; †Department of Medicine, Flinders Medical Center, Bedford Park, Australia; ‡Head and Neck Cancer Service, Westmead Hospital, Sydney, Australia; §PeterMac Cancer Center, East Melbourne, Australia; ‖Central Clinical School, University of Sydney, Sydney, Australia; ¶Adelaide Radiotherapy Center, Adelaide, Australia; #Adelaide Pathology Partners, Adelaide, Australia; **Surgical Pathology Division, SA Pathology, Adelaide, Australia; ††Department of Dermatology, Queen Elizabeth Hospital, Woodville, Australia; ‡‡John Flynn Hospital, Tugun, Australia; §§Mid North Coast Dermatology, Port Macquarie, Australia; ‖‖Dermatology SA, Norwood, Australia; ¶¶Southport Dermatology, Southport, Australia; ##Dermatologic Surgery Unit, Skin Cancer Institute, Tauranga, Bay of Plenty, New Zealand; ***Sach Day Surgery, Adelaide, Australia; †††Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, Australia; ‡‡‡Adelaide Plastic Surgery Associates, Adelaide, Australia; §§§Department of Plastic and Reconstructive Surgery, Flinders Medical Center, Bedford Park, Australia; ‖‖‖West Lakes Day Surgery, West Lakes, Australia; ¶¶¶South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, Australia; ###Adelaide Skin and Eye Center, Kent Town, Australia.
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D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome