Metastasis to the finger of oral floor squamous cell carcino
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The patient was a 65-year-old male with no systemic illness and no history of tobacco use. In December 2014, the patient was seen by a dentist due to a mass on his oral floor and difficulty moving his tongue for 2 weeks. He was referred to our department for diagnostics and treatment.

The patient presented with a 15 × 10 mm rough mass with an ulcer, erythema, and induration on the left oral floor, and no abnormal findings on extraoral examination. Positron emission tomography-computed tomography scan showed a metastatic lesion in a left submandibular lymph node that was significantly edematous (20 × 18 mm) with no ring enhancement.The clinical diagnosis was a left oral floor SCC with clinical staging of T1N1M0.

Tracheotomy, tumor resection (including mandibular marginal resection), left modified radical neck dissection (type II), and a free forearm flap transplantation were carried out in December 2014. The margins of the excised tumor were tumor-free. The final clinical staging was pT1N2bM0, and there was more lymph metastasis than the previous CT revealed. Therefore, prophylactic postoperative chemoradiotherapy was chosen as a course of treatment (radiotherapy: 59.5 Gy/30 Fr and chemotherapy: Cisplatin [80 mg/m2] + 5FU [800 mg/m2] × 2 times).

After postoperative chemoradiotherapy, the patient returned routinely for monthly follow-up visits. Eleven months after the operation, multiple lung metastases were discovered in a chest CT image. The patient was not a candidate for surgery due to the multifocality of the lesions; therefore, only chemotherapy was performed. Cetuximab and paclitaxel were administered for 8 months and stopped in April 2016 due to paronychia of all fingers, seemingly a side effect of cetuximab. Subsequently, titanium silicate (TS) and docetaxel were administered continuously for 3 months. In October 2016 (22 months after presentation/diagnosis of oral cancer), the fingernails changed color, and in November 2016, the right middle finger nail peeled off (Figure 2). In December 2016 (2 years after excision of the primary wetumor), the patient complained of severe pain and edema in the right middle finger. A dermatologist diagnosed phlegmon and prescribed antibiotics. However, the edema worsened. In March 2017, in association with increasing blood calcium concentration, multiple bone metastases were discovered by bone scintigraphy. Moreover, X-ray revealed well-circumscribed bone resorption in the right middle finger and cytology showed SCC. Therefore, it diagnosed as metastasis to the finger secondary to lung metastasis.