Nasal tip metastasis from esophageal carcinoma
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* Chun-han Chau
* Wing-tai Siu
* Michael Ka-wah Li

Cutaneous metastasis from esophageal cancer is relatively infrequent, and metastasis to the nasal tip is rare. We treated a patient who had nasal tip metastasis from squamous cell carcinoma of the esophagus that was found after repeated instrumentation.

A 54-year-old man presented with painless progessive dysphagia and weight loss. He had history of alcoholic liver cirrhosis. On physical examination, a lymph node 2 cm in dimension was palpable over the right supraclavicular fossa, and there was alcoholism-related rosacea. Endoscopy revealed a tumour at the midesophagus, and biopsy specimens obtained from the esophageal tumour and lymph node showed squamous cell carcinoma. In view of the distant metastasis and liver cirrhosis, palliative radiotherapy was given. Since the initial diagnosis he had relied on finebore nasogastric tube feeding because of persistent dysphagia. He suffered repeated esophageal blockage, for which he underwent multiple sessions of bronchoscopically guided feeding tube insertion.

Metastases in the nasal cavity were found on subsequent endoscopy. Four months after the initial diagnosis, we noticed a rapid increase in the area of the nasal rosacea with marked telangiectasia and central necrosis (Fig. 1). Biopsy confirmed metastatic squamous cell carcinoma.

![FIG. 1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/45/3/224.2/F1.medium.gif)

[FIG. 1](http://canjsurg.ca/content/45/3/224.2/F1)

FIG. 1 
Nasal tip metastasis from esophageal cancer.

Cutaneous metastasis of esophageal carcinoma is rare, accounting for only 1% of distant disease.1 This is probably the first reported case of nasal tip metastasis from esophageal carcinoma. This unusual location of metastasis is probably secondary to tumour seeding of the traumatized nasal mucosa after repeated instrumentation and long-term use of a feeding tube. Another possibility is that the locally advanced tumour with cervical lymphadenopathy blocks the lymphatic drainage of the nose and causes retrograde spread of the disease. Systemic spread of the tumour cells to a pre-existing vascular lesion (rosacea) is a remote possibility.

The differential diagnosis of nasal metastasis should include rosacea, rhinophyma, pseudolymphoma and sarcoidosis. In patients with malignant disease, biopsy should be performed for any suspicious skin lesion even if it is in an unusual location.

## Reference

1.  Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer 1995;76:1120–5.
    
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    [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=8630886&link_type=MED&atom=%2Fcjs%2F45%2F3%2F224.2.atom)