In-Transit Metastasis of Cutaneous Squamous Cell Carcinoma With Lymphovascular Invasion in an Immunocompetent Patient

In-transit metastases of melanoma and non-melanoma skin cancers are metastases located in the skin or subcutaneous tissue between the primary tumor and the nearest nodal basin. Although rare, in-transit cutaneous squamous cell carcinoma (SCC) is an emerging diagnosis in immunocompromised and immunocompetent patients that may have significant implications on treatment and prognosis. Lymphovascular invasion is an uncommon high-risk feature of SCC. Here, we present a case of a 73-year-old non-immunosuppressed man with no previous history of skin cancer, found to have in-transit metastasis with lymphovascular invasion during Mohs surgery for a primary SCC of his right ear. Patients with in-transit SCC should receive further staging imaging and a multimodal approach to treatment, including Mohs micrographic surgery, adjuvant radiation, and possibly sentinel lymph node biopsy and immunotherapy or chemotherapy.