case_images: PMC11366091_01
case_images: On examination, around 10 cm x 8 cm mass was noted on the left upper back, soft in consistency, mildly tender with central ulceration and serosanguinous fluid, non-foul-smelling oozing out of it.
case_images: 10.1177_23247096241271977-fig1.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig1.jpg
case_images: fig1-23247096241271977
case_images: On examination, around 10 cm x 8 cm mass was noted on the left upper back with central ulceration and serosanguinous fluid, non-foul-smelling oozing out of it (Figure 1).
case_images: CT thoracic spine axial view showing 9.3 cm lesion on upper back marked by the red arrow.
case_images: 10.1177_23247096241271977-fig2.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig2.jpg
case_images: fig2-23247096241271977
case_images: Computed tomography thoracic spine was done and showed 7.5 cm x 9 cm x 4.2 cm heterogeneous well-defined superficial soft tissue mass in the left upper back with infiltration to the adipose tissue (Figure 2).
case_images: Wide local excision of the tumor mass on the upper back.
case_images: 10.1177_23247096241271977-fig3.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig3.jpg
case_images: fig3-23247096241271977
case_images: The patient was planned for wide local excision of the mass (Figure 3) that was done with a pathology report (Figures 4 and 5) showing invasive high-grade SCC, poorly differentiated with marked cytological atypia and foci of tumor necrosis.
case_images: Showing 40x magnification area with dense pink cytoplasmic keratinization marked by the red arrow and H&E staining showing cells suggestive of features of SCC.
case_images: 10.1177_23247096241271977-fig4.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig4.jpg
case_images: fig4-23247096241271977
case_images: The patient was planned for wide local excision of the mass (Figure 3) that was done with a pathology report (Figures 4 and 5) showing invasive high-grade SCC, poorly differentiated with marked cytological atypia and foci of tumor necrosis.
case_images: Showing high power field (HPF) 100x magnification of cells with features of invasive, high-grade, poorly differentiated with marked cytological atypia shown by the red arrow and foci of tumor necrosis of SCC.
case_images: 10.1177_23247096241271977-fig5.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig5.jpg
case_images: fig5-23247096241271977
case_images: The patient was planned for wide local excision of the mass (Figure 3) that was done with a pathology report (Figures 4 and 5) showing invasive high-grade SCC, poorly differentiated with marked cytological atypia and foci of tumor necrosis.
case_images: (A) Axial view PET scan showing heterogeneous hypermetabolic activity in skin thickening in the left upper back, marked by the red arrow, approximately 9.3 cm in length. The standard uptake values of this activity range from 3.5 to 4.4. (B) Sagittal view PET scan showing heterogeneous hypermetabolic activity in skin thickening in the left upper back, marked by the red arrow, approximately 9.3 cm in length. The standard uptake values of this activity range from 3.5 to 4.4.
case_images: 10.1177_23247096241271977-fig6.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig6.jpg
case_images: fig6-23247096241271977
case_images: Positron emission tomography-computed tomography (PET-CT) scan done:hypermetabolic skin thickening in the left upper back (Figure 6A and B), hypermetabolic subcutaneous nodule/lymph node in the left posterolateral upper back with hypermetabolic left axillary lymphadenopathy noted (Figure 7), which is most consistent with metastatic nodal disease.
case_images: Positron emission tomography (PET) scan image showing left axillary lymphadenopathy as marked by blue and red arrows with largest one approximately 1 cm that were resected and showed associated perinodal soft tissue invasion seen in 1 of the 2 lymph nodes.
case_images: 10.1177_23247096241271977-fig7.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig7.jpg
case_images: fig7-23247096241271977
case_images: Positron emission tomography-computed tomography (PET-CT) scan done:hypermetabolic skin thickening in the left upper back (Figure 6A and B), hypermetabolic subcutaneous nodule/lymph node in the left posterolateral upper back with hypermetabolic left axillary lymphadenopathy noted (Figure 7), which is most consistent with metastatic nodal disease.
case_images: Surveillance PET scan done 1 year later showed a new hypermetabolic 2.2 cm nodule (marked by the red arrow) in the skin and subcutaneous tissues inferior to the mildly hypermetabolic soft tissue changes in the left upper back with the standard uptake values (SUV) ranging from 5.8 to 11.2.
case_images: 10.1177_23247096241271977-fig8.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig8.jpg
case_images: fig8-23247096241271977
case_images: After completion of RT and receiving 3 cycles of immune checkpoint inhibitor (ICI), the patient underwent his first surveillance PET scan (approximately 9 months after the diagnosis), which showed interval resolution of the hypermetabolic activity in the left axillary lymph nodes; however, a new hypermetabolic 2.2 cm nodule appeared in the skin and subcutaneous tissues inferior to the mildly hypermetabolic soft tissue changes in the left upper back with the standard uptake values (SUV) ranging from 5.8 to 11.2 (Figure 8).
case_images: After 1 year of treatment on examination, the site of the lesion appeared well-healed with no clinical palpable nodule.
case_images: 10.1177_23247096241271977-fig9.jpg
case_images: PMC11366091_01_10.1177_23247096241271977-fig9.jpg
case_images: fig9-23247096241271977
case_images: On examination, the site of the lesion appeared well-healed with no clinical palpable nodule or lymph node in the axilla (Figure 9).