Cutaneous Lesions in a Case of Recurrent Carcinoma Buccal Mucosa on FDG/PET

47-year-old male, a known case of carcinoma of the left buccal mucosa, underwent composite resection and free flap reconstruction followed by adjuvant radiotherapy. A few years later, developed subglottic carcinoma and received low-dose immunotherapy and Erlotinib, Methotrexate and Celecoxib. 2-4 weeks later, the patient started developing an extensive cutaneous Grade 3 maculopapular rash followed by lichenoid pustular eruptions all over the trunk and extremities (D). 6 weeks later, the patient presented in casualty with Grade 4 neutropenia, Grade 3 anaemia, Grade 1 thrombocytopenia, Grade 1 dyspnoea and hypotension, which was managed intensively. He underwent an 18F-FDG PET/CT scan for assessment of disease status. Maximum intensity projection (MIP) (A) and fused sagittal PET/CT images (B) show extensive skin and subcutaneous nodular lesions, which can be seen on axial fused PET and PET/CT (C) images and also on clinical examination (D).

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Fig 1: (A) Maximum intensity projection (MIP) image of 18F-FDG PET demonstrating diffuse foci of tracer uptake over the trunk and extremities, corresponding to widespread cutaneous involvement in a background of significant decrease in metabolism and morphological extent of neoplastic lesion in sub glottis and metastatic right cervical nodes. (B) Fused coronal 18F-FDG PET/CT image showing multiple foci of abnormal tracer uptake in cutaneous in skin and subcutaneous region. (C) Fused axial PET and fused PET/CT images at the level of abdomen and pelvis demonstrating multiple foci of abnormal tracer uptake in cutaneous plane. (D) Clinical photograph of left forearm showing extensive cutaneous maculopapular rash and lichenoid pustular eruptions with crusting consistent with cutaneous adverse event. FDG: Fluorodeoxyglucose; PET/CT: Positron emission tomography/computed tomography

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