Meter Monet E, Nye David J, Galvez Christian R
Department of Medicine, Sky Ridge Medical Center, Lone Tree, CO, USA.
Department of Surgery, Berkshire Medical Center, Pittsfield, MA, USA.
Case Rep Surg. 2017;2017:4176071. doi: 10.1155/2017/4176071. Epub 2017 Mar 13.
It is rare for actinic or squamous cell carcinoma (SCC) in situ to metastasize. 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. 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. 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.
光化性或原位鳞状细胞癌（SCC）发生转移的情况较为罕见。一名67岁男性有重要病史，包括曾用紫外线B、甲氨蝶呤和雷帕霉素治疗严重的银屑病关节炎。他有25次不同的光化性角化病皮肤切除术，其中4次为浸润性SCC。我们的患者出现呼吸急促，需要前往急诊科就诊。他胸部的CT扫描显示右下肺有一个肿块。随后对该肿块进行活检，结果显示为高分化SCC。他接受了胸腔镜手术，对肺部病变进行楔形切除术。光化性角化病（AK）被认为是癌前病变，与紫外线暴露有关。它以一种具有低恶性潜能的连续进展形式存在。大多数浸润性SCC与AK的恶性进展相关，但只有5%-10%的AK会发展为具有恶性潜能。在这种情况下，在有广泛紫外线暴露和免疫抑制病史的多例浸润性光化性皮肤SCC背景下出现肺部SCC这一新发现，支持了肺癌的转移解释。
