HPV16-Positive Skin Metastasis at the Nose 5 Years Following Treatment of an HPV16-Positive Squamous Cell Carcinoma of the Tonsil – A Case Report and Review of Literature

Abstract

This case report presents the disease course of a patient who developed HPV16-positive skin metastasis to the nose of HPV16-positive tonsillar carcinoma treated 5 years previously. The report critically reviews the available literature, particularly the comparable case reports available to date. In light of conflicting findings, it now appears unclear whether the occurrence of skin metastases reflecting an unusual pattern of metastasis is more typical of the course of HPV-positive HN/OSCC. There are reports suggesting this association, including our case report. On the other hand, there are retrospective study results that rather do not point to an association of skin metastases explicitly with (HPV-positive) OSCC. Rather, it must be critically questioned whether there is indeed a significant association between a specific metastatic pattern including unusual metastatic sites such as the skin, or whether merely increased attention to HPV-positive cancers leads to a higher publication rate of these cases. Extensive epidemiologic evidence should be obtained on a retrospective and prospective basis before recommendations for surveillance of corresponding patients are derived from the assumption of an atypical or different metastatic pattern in HPV-positive HNSCC.