Acral Metastasis: A Very Rare Metastatic Site from Basaloid Squamous Cell Carcinoma of the Tonsil

Basaloid squamous cell carcinoma (BSCC) is a variant of squamous cell carcinoma occuring in the tonsils. To the best of our knowledge, this represents the first report of acral metastasis from BSCC of the tonsil. We report a 46-year-old male with BSCC of the tonsil, with initial T2N0M0 treated with surgery and adjuvant chemo-radiation. Post treatment surveillance clinical examination, endoscopy and computed tomography scan did not reveal any signs of loco-regional recurrence. Three years later, he presented with pain and swelling of the distal phalanx of the left middle finger. Palliative Ray amputation of the distal phalanx of left middle finger was performed with histopathological evidence of metastatic basaloid squamous cell carcinoma. Scrutiny of the distal phalanx specimen and the initial tumour in the tonsil showed morphologically similar tumour concluding metastatic BSCC of the left middle phalanx. Acral metastasis is rare in squamous cell carcinoma of the tonsil but can occur years after completion of treatment.