Unexpected metastatic malignancy
The patient was treated with antibiotics, however the swelling increased. The area felt firm and there was slight ulceration of the overlying epidermis.
A skin biopsy showed metastatic squamous cell carcinoma (SCC). The patient was immunosuppressed and had had a poorly differentiated SCC elsewhere. His immunosuppressed state was undoubtedly a factor in this blood metastasis.
Merkel cell carcinoma is more likely to present in this way as a haematogenous skin metastasis in immunosuppressed patients. PET scans showed other spread so chemotherapy was the only