Lung Adenocarcinoma With Rare Skin Metastasis to the Neck

What happened, in summary

A 51-year-old man had been diagnosed with Stage III adenocarcinoma of the right lung about 2 years before developing a new problem: progressive swelling and hardening of his face and neck. The skin became firm and leather-like, and over 6 months the changes became severe enough to limit movement of his neck and make swallowing difficult.

He had previously undergone surgery for the lung cancer, followed by systemic treatment with pemetrexed and carboplatin together with bevacizumab. When the neck changes appeared, imaging showed abnormal thickening in the neck tissues. A skin biopsy found malignant cells in the dermis, and staining supported a lung origin. The diagnosis was carcinoma en cuirasse, a rare form of skin metastasis that can cause diffuse thickening and hardening rather than a typical skin nodule.

This finding meant that the lung cancer had progressed beyond its original Stage III presentation to metastatic disease. He was transferred to oncology for further management. About 3 months later, however, he stopped treatment because of financial constraints. He died during the following year of follow-up. The case highlights an unusual way lung adenocarcinoma can spread to the skin and produce symptoms that can initially resemble a non-cancerous skin or connective-tissue disorder.