Lymphoepithelioma-like Carcinoma of the Skin in the Cheek with a Malignant Metastatic Cervical Lymph Node

Since first described by Swanson et al. in 1988, lymphoepithelioma-like carcinoma of the skin (LELCS) has been considered a rare malignant skin tumor. It is usually caused by sun exposure and is therefore most prevalent on the skin of the head and neck in elderly individuals. Although the histologic etiology of LELCS is still unclear, it is known to have a slight tendency toward local recurrence and extremely low metastatic potential. Approximately 70 cases have been reported in the literature to date [1]. Among them, only a few reports have described local recurrence or metastasis to lymph nodes, and only one reported death due to distant metastasis of LELCS. In Korea, two LELCS cases have been reported in the Korean language. However, both cases had no local recurrence or lymph node metastasis nor any long-term follow-up data. We report the first case of LELCS with a malignant metastatic cervical lymph node in a Korean. A 71-year-old male with a skin lesion of the right cheek, which appeared several months prior to presentation, visited our hospital. Clinically, the lesion presented as soft, mobile over the underlying tissues, and painless, with a diameter of 5 mm and an erythematous macule with central eschar caused by a punch biopsy at an another hospital (Fig. 1). He did not have any palpable lymphadenopathy or nasopharyngeal symptoms. The slide from the other hospital was reevaluated in our hospital; poorly differentiated carcinoma was identified in the dermis. Magnetic resonance imaging (MRI) showed a focal defect lesion approximately 5 mm in size surrounding the enhancement with an ambiguous impression suggesting either tumor enhancement or a postbiopsy reaction (Fig. 2), and a whole-body positron emission tomography (PET) scan showed skin thickening with focal hypermetabolism in the right cheek. In ultrasonography (USG), palpable and abnormal lymph nodes were not observed. Surgical treatment was performed with wide excision (surgical