This post is an answer to the Case – A 70-year-old Man With an Itchy Rash
His clinical admission diagnosis was herpes zoster virus infection, and he had been previously treated with both acyclovir and brivudine 2 months ago for a total of 10 days each, without clinical improvement.
Medical history revealed a lymph node metastasis of a squamous cell carcinoma of unknown primary in the right axilla that had been removed 2 years earlier followed by local radiotherapy of the axilla.
Further clinical examination showed an ulcerative lesion on the distal phalanx on the right middle-finger and lymphoedema of the entire right arm. The digital tumour had been present for more than 4 years but had never previously been paid attention to.
Histopathological, immunohistochemical, and virological analyses confirmed the suspected diagnosis of human papillomavirus (HPV)-associated periungual squamous cell carcinoma with widespread cutaneous metastases. HPV typing was performed with group-specific PCR and reverse line blot hybridisation (Inno-LiPA genotyping extra II assay) and revealed HPV6 and HPV16 in the periungual squamous cell carcinoma and in the cutaneous chest metastases.
