skin metastases from head and neck squamous cell carcinoma are rare and usually occur near the primary site . cancer of the oral cavity makes up approximately 30% of all head and neck region tumors . carcinoma of the buccal mucosa is the most common carcinoma of the oral cavity in south - east asia because of the widespread use of betel nut . with multimodality treatment , locoregional control of head and neck squamous cell carcinoma ( hnscc ) has improved nowadays . however , skin metastasis usually occurs in the neck , scalp , and over the skin near the primary site . we report a patient with carcinoma left buccal mucosa who presented with distant skin metastases to the right side chest wall . a 30-year - old male , chronic tobacco chewer , presented to the oncology clinic with 2 months history of an ulcer over left buccal mucosa . the patient was well built and had eastern cooperative oncology group performance score of 1 . on locoregional examination , he had a 3 cm  4 cm ulceroproliferative growth over the left buccal mucosa involving the angle of mouth reaching up to left retromolar trigone involving the upper gingivobuccal sulcus . contrast enhanced computed tomography ( cect ) scan neck reported diffuse soft tissue thickening along the left buccal mucosa extending along upper and lower lip to mid - sagittal plane and reaching up to superior gingivobuccal sulcus posteriorly in the region of premolars . biopsy from the growth reported keratinizing squamous cell carcinoma . all other baseline investigations including a complete hemogram , kidney function tests , liver function tests , and chest x - ray were within normal limits . in view of the above findings , the patient was diagnosed as carcinoma of the left buccal mucosa ct4an0m0 ( ajcc ) stage iva . the patient underwent wide local excision of the lesion with left modified neck dissection with flap reconstruction . postoperative histopathology reported well differentiated squamous cell carcinoma of size 1 cm  0.8 cm  0.7 cm with the involvement of overlying skin and 5 out of 36 lymph nodes dissected were positive - pt4an2bmx stage iva . in view of the histopathology findings patient received adjuvant external beam radiotherapy 66 gy in 33 fractions to the planning target volume by inverse planned intensity modulated radiotherapy technique on varian clinac ix by 6 mv photons with weekly concurrent cisplatin - based chemotherapy . he reported again after 3 months with complaints of a lump over the right side of the chest wall for which he had consulted a local doctor and underwent excision of the lump at a local hospital . a 5 cm  4 cm subcutaneous lump was palpable over the right lateral chest wall . whole body positron emission tomography - ct scan was done which reported hypermetabolic subcutaneous nodular lesion along right lateral chest wall - likely metastatic , no evidence of residual primary lesion or abnormal uptake at any other site [ figure 1 ] . the patient underwent wide excision of the right chest wall lesion [ figure 2 ] . postoperatively , he received external radiotherapy to the postoperative region by electron beam ( 50 gy/20 fractions ) . his blood investigations revealed hypercalcemia and was managed conservatively but patient defaulted from further treatment . positron emission tomography - computed tomography showing isolated hypermetabolic nodular lesion along right lateral chest wall subcutaneous nodule over right side chest wall squamous cell carcinoma involving the subcutaneous fat ( h and e , 200 ) sections show nests and sheets of dysplastic cells with intercellular bridges displaying high n : c ratio , abundant cytoplasm , a vesicular nucleus with prominent nucleoli . the frequency of skin metastasis from all internal malignancies varies from 0.7% to 9% of all cancer patients . schultz and schwartz had reported a rare presentation of cutaneous metastasis from carcinoma of the hypopharynx way back in 1985 . veraldi et al . , noted rarity of skin metastasis from laryngeal cancers and showed only 12 reported cases in literature . skin metastasis is thought to involve hematogenous spread where pulmonary circulation and filtration can be theoretically bypassed via the azygos venous and vertebral venous system in batson 's plexus allowing skin implantation . berger and fletcher in their study reported that length of survival was approximately 3 months after skin metastasis becomes clinically evident in hnscc . the treatment intent is usually palliative with the available options being surgical excision , chemotherapy , external beam radiotherapy or a combination of these . whatever the nature of the primary lesion , the course of the disease or treatment ( s ) administered , it appears that skin metastasis is an equalizing factor for all patient groups in carcinoma of head and neck , all patients do poorly and succumb rapidly to the disease . distant skin metastasis from hnscc is hardly reported in literature to the best of our knowledge . the appearance of new skin lesions in patients of hnscc mandates a vigilant history and thorough physical examination . distant skin metastasis from head and neck squamous cell carcinoma ( hnscc ) has hardly been reported in the literature . in the event of the appearance of new skin lesions in a previously diagnosed patient of hnscc distant skin metastasis from head and neck squamous cell carcinoma ( hnscc ) has hardly been reported in the literature . in the event of the appearance of new skin lesions in a previously diagnosed patient of hnscc distant skin metastasis from head and neck squamous cell carcinoma ( hnscc ) has hardly been reported in the literature . in the event of the appearance of new skin lesions in a previously diagnosed patient of hnscc
cancer of the oral cavity makes up approximately 30% of all head and neck region tumors . 
 skin metastasis is rare with an incidence ranging between 0.7% and 2.4% . 
 skin metastasis usually occurs in the neck , scalp , and over the skin near the primary site . 
 we report a patient with carcinoma left buccal mucosa who presented with distant skin metastases to the right side chest wall .