title: Suspected Pulmonary Metastasis of Actinic Cutaneous Squamous Cell Carcinoma.
abstract: Introduction.It is rare for actinic or squamous cell carcinoma (SCC) in situ to metastasize.Case Presentation.A 67-year-old male had a significant medical history including severe psoriatic arthritis treated with UVB, methotrexate, and rapamycin. He had twenty-five different skin excisions of actinic keratosis four of which were invasive SCC. Our patient developed shortness of breath necessitating a visit to the emergency department. A CT scan of his chest revealed a mass in the right lower lung. A subsequent biopsy of the mass revealed well-differentiated SCC. He underwent thoracoscopic surgery with wedge resection of the lung lesion.Discussion.Actinic keratosis (AK) is considered precancerous and associated with UV exposure. It exists as a continuum of progression with low potential for malignancy. The majority of invasive SCCs are associated with malignant progression of AK, but only 5-10% of AKs will progress to malignant potential.Conclusion.In this case, a new finding of lung SCC in the setting of multiple invasive actinic cutaneous SCC associated with a history of extensive UV light exposure and immunosuppression supports a metastatic explanation for lung cancer.
authors.affiliation: Department of Medicine, Sky Ridge Medical Center, Lone Tree, CO, USA.
authors.forename: Monet E
authors.initials: ME
authors.lastname: Meter
authors.affiliation: Department of Surgery, Berkshire Medical Center, Pittsfield, MA, USA.
authors.forename: David J
authors.identifier: 0000-0002-0153-8289
authors.initials: DJ
authors.lastname: Nye
authors.affiliation: Department of Surgery, Berkshire Medical Center, Pittsfield, MA, USA.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Galvez