A Rare Case of Ulceronodular Cutaneous Metastases from Nasopharyngeal Carcinoma

Abstract

Nasopharyngeal cancer is a rare cancer in most part of the world, but commonly seen in natives of southern China, Southeast Asia, the Arctic, and the Middle East/North Africa. It is sensitive to radiotherapy and chemotherapy and is usually treated by chemoradiation. It is highly predisposed to nodal and distant metastasis. Still, cutaneous metastasis is rarely seen. Here in this report, we present the case of nasopharyngeal carcinoma with an ulceronodular type of cutaneous metastasis, presenting six years after the initial diagnosis without any visceral metastases. Another feature noted in our patient was the sensitivity to low dose radiotherapy both for bulky primary disease which was progressive on 5Fluorouracil (5FU) and cisplatin based chemotherapy, and subsequent metastases. Theoretically, skin metastases can occur through spread via dermal lymphatics or when the pulmonary filtration is bypassed via the vertebral venous system and Batson’s plexus allowing skin implantation. Further, resistance to chemotherapy and high sensitivity to radiation suggests heterogeneity among nasopharyngeal cancers with intrinsic molecular subtype. The good response of metastatic disease to short course radiation suggests that patients with cutaneous and nodal metastases without visceral metastases could be aggressively treated and the patient can have a good quality of life.

Keywords

• chemoresistance
• nasopharyngeal cancer
• radiosensitivity