Brief ReportAn Unusual Histopathological Presentation of Epidermotropic Metastatic Pharyngeal Squamous Cell CarcinomaSavari, Omid MD*; Shahabi, Ali MD*; Bennett, Lauren PA-C†; Somach, Stephen MD*,† Author Information Departments of *Pathology, and †Dermatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. Correspondence: Omid Savari, MD, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109 (e-mail: [email protected]). The authors declare no conflicts of interest. The American Journal of Dermatopathology: November 2020 - Volume 42 - Issue 11 - p 858-860 doi: 10.1097/DAD.0000000000001688 Buy Metrics Abstract Epidermotropic metastasis of head and neck squamous cell carcinoma is rare. We report a case of a 56-year-old white man with a history of oral squamous cell carcinoma who presented with multiple papules on the face, eyelid, and chest wall. The histopathologic examination of the skin lesions revealed nests of malignant cells with basaloid features and zones of cytoplasmic vacuolization predominantly within the dermis but focally involving the epidermis. Central necrosis, focal papilla formation, and lymph-vascular invasion were also seen. Two of these lesions, each read by different dermatopathologists, were initially diagnosed as sebaceous carcinoma. However, further evaluation, including adipophilin immunohistochemistry, confirmed the metastatic nature of the skin lesions. Cytoplasmic vacuolization in metastatic deposits of squamous cell carcinoma may mimic primary sebaceous carcinoma. This presentation highlights the need to consider the possibility of a metastatic deposit when making a diagnosis of primary sebaceous carcinoma. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.