A Rare Case of Zosteriform Cutaneous Metastases from Squamous Cell Carcinoma of Hard Palate

A 70-year-old woman presented with painful nodules on the left side of the neck of 1 month duration. Upon questioning, the patient gave history of reverse smoking since 50 years. On examination, the patient had a superficial ulcer over the hard palate. A provisional diagnosis of zosteriform cutaneous metastases was made. Fine needle aspiration cytology of the nodule performed showed metastatic squamous cell carcinoma deposits. Later, biopsy was performed from the neck lesion and oral lesion, and it confirmed the diagnosis. Histopathology of the oral biopsy was suggestive of infiltrating squamous cell carcinoma. Biopsy of neck lesion was suggestive of squamous cell carcinoma secondaries. Majority of these cases can be misdiagnosed as herpes zoster and were treated with antiviral drugs. Distant metastases from oral squamous cell carcinoma are unusual, but generally occur in lungs, bone, and liver. Cutaneous metastasis is extremely rare, and it often reflects an advanced stage with sinister prognosis. Therefore, metastatic diseases should be considered in the differential diagnosis of zosteriform rash in the elderly.