A 55-year-old male, diagnosed case of squamous cell carcinoma of the pyriform sinus stage T4N1M0, who completed concurrent chemoradiotherapy 5 months back, presented with painful firm, globular swelling of the tips of the left thumb and fourth finger [Figure 1]. On evaluation, there was no lesion identified at the primary site. Computed tomography of the thorax showed multiple lung metastases. Biopsy of the finger swelling showed deposits of squamous cell carcinoma [Figure 2]. However, after the biopsy, the patient had profuse bleeding from the biopsy site that was managed temporarily with adrenaline packs. The patient was started on palliative chemotherapy with paclitaxel and carboplatin following which his bleeding subsided and after 2 cycles the swellings showed reduction in the size.
Figure 1.
Globular swelling of the fingertips with adrenaline pack at biopsy site
Figure 2.
Biopsy showing squamous cell carcinoma
Acrometastases arising from head and neck primaries, especially to the soft tissues of digits are very rare. The most common primary organs involved are lung, breast, and kidney. Caution has to be taken while performing biopsies as these soft-tissue metastases have a high bleeding tendency.
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