case_images: PMC10601823_01
case_images: Selected axial T1 fat-saturated contrast-enhanced images demonstrating a left-sided enhancing retroorbital mass involving superior rectus muscle and abutting the optic nerve prior to treatment.
case_images: cro-2023-0016-0001-533759_F01.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F01.jpg
case_images: F1
case_images: One year later, he unfortunately developed a biopsy-proven recurrence with a lesion in the superior orbit with perineural spread as far as the cavernous sinus, which was complicated by proptosis and ophthalmoplegia (Fig. 1, 2).
case_images: Selected coronal T1 fat-saturated contrast-enhanced images demonstrating a left-sided enhancing retroorbital mass involving superior rectus muscle and abutting the optic nerve prior to treatment.
case_images: cro-2023-0016-0001-533759_F02.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F02.jpg
case_images: F2
case_images: One year later, he unfortunately developed a biopsy-proven recurrence with a lesion in the superior orbit with perineural spread as far as the cavernous sinus, which was complicated by proptosis and ophthalmoplegia (Fig. 1, 2).
case_images: Pre-treatment photos showing recurrence of metastatic CSCC adjacent to previously resected area on left scalp; partial ptosis of left eye from perineural invasion.
case_images: cro-2023-0016-0001-533759_F03.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F03.jpg
case_images: F3
case_images: He also developed intradermal recurrence lateral to the original grafted area on his left scalp (Fig. 3, 4).
case_images: Pre-treatment photos showing recurrence of metastatic CSCC adjacent to previously resected area on left scalp; partial ptosis of left eye from perineural invasion.
case_images: cro-2023-0016-0001-533759_F04.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F04.jpg
case_images: F4
case_images: He also developed intradermal recurrence lateral to the original grafted area on his left scalp (Fig. 3, 4).
case_images: Selected coronal T1 fat-saturated contrast-enhanced images demonstrating significant response in the retroorbital mass following three cycles of cemiplimab.
case_images: cro-2023-0016-0001-533759_F05.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F05.jpg
case_images: F5
case_images: He was commenced on cemiplimab and showed promising response after 2 cycles with partial resolution of his diplopia and proptosis as well as visible improvement in intradermal recurrence (Fig. 5-8).
case_images: Selected axial T1 fat-saturated contrast-enhanced images demonstrating significant response in the retroorbital mass following three cycles of cemiplimab.
case_images: cro-2023-0016-0001-533759_F06.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F06.jpg
case_images: F6
case_images: He was commenced on cemiplimab and showed promising response after 2 cycles with partial resolution of his diplopia and proptosis as well as visible improvement in intradermal recurrence (Fig. 5-8).
case_images: Reduction in size of CSCC and improvement in left ptosis after 2 cycles of cemiplimab.
case_images: cro-2023-0016-0001-533759_F07.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F07.jpg
case_images: F7
case_images: He was commenced on cemiplimab and showed promising response after 2 cycles with partial resolution of his diplopia and proptosis as well as visible improvement in intradermal recurrence (Fig. 5-8).
case_images: Reduction in size of CSCC and improvement in left ptosis after 2 cycles of cemiplimab.
case_images: cro-2023-0016-0001-533759_F08.jpg
case_images: PMC10601823_01_cro-2023-0016-0001-533759_F08.jpg
case_images: F8
case_images: He was commenced on cemiplimab and showed promising response after 2 cycles with partial resolution of his diplopia and proptosis as well as visible improvement in intradermal recurrence (Fig. 5-8).
case_images: PMC10601823_02
case_images: Large ulcerated lesion on the right posterior neck area.
case_images: cro-2023-0016-0001-533759_F09.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F09.jpg
case_images: F9
case_images: A 75-year-old man with aggressive metastatic CSCC presented with a primary lesion in his right mastoid area (Fig. 9, 10).
case_images: Large ulcerated lesion on the right posterior neck area.
case_images: cro-2023-0016-0001-533759_F10.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F10.jpg
case_images: F10
case_images: A 75-year-old man with aggressive metastatic CSCC presented with a primary lesion in his right mastoid area (Fig. 9, 10).
case_images: Axial slice of contrast-enhanced CT neck pre-treatment showing large necrotic adenopathy in right posterior triangle with muscle invasion.
case_images: cro-2023-0016-0001-533759_F11.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F11.jpg
case_images: F11
case_images: The lesion was initially excised in November 2022; however, a month later, he presented with two rapidly growing, fungating lesions on his posterior neck extending down to the supraclavicular fossa with muscle invasion demonstrated on CT neck (Fig. 11).
case_images: Reduction in lesion size after 2 cycles of nivolumab.
case_images: cro-2023-0016-0001-533759_F12.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F12.jpg
case_images: F12
case_images: He was commenced on nivolumab in March 2023 and demonstrated dramatic response with >50% size reduction of his CSCC after 2 cycles of treatment (Fig. 12, 13).
case_images: Reduction in lesion size after 2 cycles of nivolumab.
case_images: cro-2023-0016-0001-533759_F13.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F13.jpg
case_images: F13
case_images: He was commenced on nivolumab in March 2023 and demonstrated dramatic response with >50% size reduction of his CSCC after 2 cycles of treatment (Fig. 12, 13).
case_images: Lesion size after cycle 8 nivolumab.
case_images: cro-2023-0016-0001-533759_F14.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F14.jpg
case_images: F14
case_images: He subsequently continued with further cycles of nivolumab with excellent tumour size response (Fig. 14).
case_images: Axial slice of contrast-enhanced CT neck post-cycle 6 nivolumab showing interval reduction in neck mass.
case_images: cro-2023-0016-0001-533759_F15.jpg
case_images: PMC10601823_02_cro-2023-0016-0001-533759_F15.jpg
case_images: F15
case_images: CT neck restaging scan following 6 cycles of nivolumab in June 2023 demonstrated significant interval reduction in the necrotic adenopathy in the right posterior neck with some small volume residual overlying skin thickening (Fig. 15) (see Table 2 for timeline of diagnosis and treatment received).