Clinical analysis of patients with skin metastasis of cervical squamous cell carcinoma
Original Article

Clinical analysis of patients with skin metastasis of cervical squamous cell carcinoma

Yu Shen1#, Xiaoxia Jin2#, Yurui Zhu3, Chenyun He4

1Department of Dermatology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong Municipal Institute of Dermatology, Nantong, China; 2Department of Pathology, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China; 3Medical School of Nantong University, Nantong, China; 4Department of Gynecology Oncology, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China

Contributions: (I) Conception and design: C He, Y Shen; (II) Administrative support: C He; (III) Provision of study materials or patients: C He, Y Shen; (IV) Collection and assembly of data: C He, Y Shen; (V) Data analysis and interpretation: Y Shen, X Jin; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

#These authors contributed equally to this work.

Correspondence to: Chenyun He, MD. Department of Gynecology Oncology, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, 30 North Tongyang Road, Pingchao, Nantong 226361, China. Email: bjhcy2010@126.com.

Background: Cancers that metastasize to the skin are rare, especially cervical squamous cell carcinoma to the skin. Here, we have reported clinical analysis of patients with cervical squamous cell carcinoma metastasize to skin, to obtain a general understanding of this malignancy for clinicians.

Methods: A retrospective analysis of patients with skin metastasis from cervical squamous cell carcinoma was conducted, focusing on clinical manifestations, histopathology, diagnosis, treatment, and prognosis.

Results: The average age of onset for the six patients with skin metastasis from cervical squamous cell carcinoma was 55.17±17.08 years, with four cases presenting as solitary lesions and two cases as multiple lesions. Treatment strategies included local excision for isolated lesions, chemotherapy, radiotherapy, or targeted therapy based on the extent of skin involvement, and immunotherapy was proved to have promising results in our cases. Among the six patients, three have passed away with a diagnosis-to-death time of approximately 5–6 months, while three patients are alive, with survival times ranging from 30 to 72 months.

Conclusions: Skin metastasis from cervical squamous cell carcinoma is rare and often accompanies recurrent metastases to other visceral sites, necessitating early and accurate diagnosis. For isolated metastatic lesions, early detection followed by wide excision surgery and adjuvant radiotherapy can yield favorable outcomes. However, in cases of multiple skin metastases or concurrent metastases to multiple organs, treatment is challenging with a poor prognosis. Nevertheless, with advancements in medicine, combination chemotherapy, immunotherapy, and targeted therapy can effectively prolong survival, offering new hope for patients with skin metastasis from cervical cancer.

Keywords: Cervical squamous cell carcinoma; skin metastasis; targeted therapy; immunotherapy; prognosis

Submitted May 05, 2024. Accepted for publication Jun 11, 2024. Published online Jun 28, 2024.

doi: 10.21037/cco-24-60

Highlight box

Key findings

• Our study analyzed retrospectively six patients with skin metastasis from cervical squamous cell carcinoma, investigated, and summarized clinical manifestations, histopathology, diagnosis, treatment, and prognosis.

What is known and what is new?

• Skin metastasis cancer is rare, while skin metastasis from cervical cancer is even rarer, which often accompanies recurrent metastases to other visceral sites, necessitating early and accurate diagnosis.

• In cases of multiple skin metastases or concurrent metastases to multiple organs, treatment is challenging. In our cases, combination chemotherapy, immunotherapy, and targeted therapy effectively prolonged survival, offering new hope for patients with skin metastasis from cervical cancer.

What is the implication, and what should change now?

• Immunotherapy was proved to have promising results in our case and may be used as the preferred treatment for such patients in the future. With scientific advancements, new drugs or treatment methods are continually being developed to bring new hope to patients with skin metastasis from cervical cancer.

Introduction

Skin metastasis cancer refers to the skin lesions that occur when malignant tumors originating outside the skin spread through blood vessels, lymphatic vessels, or direct infiltration into the adjacent skin tissue (1). Since the skin is not a common site for tumor metastasis, skin metastasis cancer is rare, and skin metastasis from cervical cancer is even rarer (2). Here, we report the clinical characteristics, diagnosis, treatment, and prognosis of patients of cervical squamous cell carcinoma with skin metastasis treated at the Nantong Municipal Institute of Dermatology and Nantong Tumor Hospital from January 2010 to June 2023. We present this article in accordance with the STROBE reporting checklist (available at https://cco.amegroups.com/article/view/10.21037/cco-24-60/rc).

Methods

This retrospective cohort study analyzed cervical squamous cell carcinoma patients with skin metastasis treated at the Nantong Municipal Institute of Dermatology and Nantong Tumor Hospital from January 2010 to June 2023. Inclusion criteria were as follows: pathologically confirmed cervical cancer, squamous cell carcinoma, and skin metastasis. Exclusion criteria were as follows: patients did not receive any treatments, patients had incomplete data, or patients did not complete treatments. The patients with skin metastasis from cervical squamous cell carcinoma was collected, and analysis clinical manifestations, histopathology, diagnosis, treatment, and prognosis. Besides, we retrospectively reviewed the patients with comprehensive data were compiled from the literature. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Ethical clearance was provided by the Ethics Committee of the Affiliated Tumor Hospital of Nantong University (No. 2021-105), and the individual consent for this retrospective analysis was waived.

Results

General information

Six patients with cervical squamous cell carcinoma skin metastasis were included, with ages ranging from 37 to 85 years (mean age 55.17±17.08 years). The skin lesions occurred 6–48 months after treatment of the primary tumor (mean 26.17±17.59 months). All cases were confirmed by pathological histology and immunohistochemistry and received personalized treatment based on individual circumstances (Table 1).

Table 1

Clinical data of 6 patients with cervical cancer skin metastasis

No. Age (years) Initial treatment staging (period) Pathology type Metastasis site Features of skin lesions Conscious symptom Merge transfer Relapse time (months) Treatment Survival time (months)
1 85 IIB Medium differentiation, squamous cell carcinoma Right side of the face Nodules, ulcers – Two lungs 24 Surgical excision 5
2 62 IIB Low differentiation, squamous cell carcinoma Right lower back Subcutaneous mass – Right groin, lymph node 6 Surgical excision + radiotherapy >72
3 37 IIB Low differentiation, squamous cell carcinoma Left chest wall Subcutaneous nodules Mild, tenderness Left rib 48 Chemotherapy + targeted + immunity + other >50
4 51 IB2 Low differentiation, squamous cell carcinoma Left lower limb left foot and vulva Nodules, ulcers, dropsy Swell Not 47 Chemotherapy + immunization >30
5 42 IIA2 Medium differentiation, squamous cell carcinoma Scalp, fingers, etc. Multiple places throughout the body Multiple subcutaneous
tuber		 – Liver, two lungs 13 Chemotherapy 6
6 54 IIB Medium differentiation, squamous cell carcinoma Right chest wall Subcutaneous nodules Mild, tenderness Right ribs, cervix, peritoneum, upper abdominal lymph nodes 19 Chemotherapy 6

Clinical presentation

Most patients had concurrent metastases in other organs such as the lungs, peritoneum, lymph nodes, ribs, and sternum (Figure 1). Skin metastases were mainly located on the head and face, chest wall, lower back, and external genitalia, with four cases of isolated lesions (66.67%) and two cases of multiple lesions (33.33%) (Table 1). Clinical manifestations included single subcutaneous nodules or multiple nodules with ulceration, some with mild tenderness or swelling, while others were asymptomatic (Figures 2,3).

Figure 1 Chest computed tomography showing bone destruction of the sternum with the formation of soft tissue masses surrounding it, involving the skin of the chest wall (arrows) (patient 6).
Figure 2 Edema in the left lower limb, multiple varying-sized purplish-red nodules, some of which are ulcerated (patient 4).
Figure 3 PET-CT imaging showing increased uptake of [18F] fluorodeoxyglucose. The image reveals significant thickening of the left lower limb with scattered and uneven thickening of the skin, accompanied by focal and unevenly increased glucose metabolism. Small subcutaneous nodules are visible in the lower segment of the left calf and the left foot (arrows) (patient 4). PET-CT, positron emission tomography-computed tomography.

Histopathology

In our six cases, all cervical lesions were diagnosed as medium differentiation or low differentiation squamous cell carcinoma at the first detection, while all cutaneous lesions were diagnosed as consistent with cervical squamous cell carcinoma metastasis. Skin pathology revealed normal epidermis without tumor tissue. The tumor was mainly located in the dermis, showing clusters of epithelial cells with large cell volume, red-stained cytoplasm, cellular pleomorphism, mitotic figures, and central necrosis in some clusters. Some tumor cell nests located within lymphatic vessels, which lined with a single layer of flattened epithelium, and contained a little lymphatic fluid. Immunohistochemistry staining showed positivity for P16, CK5/6, and P63 (Figure 4).

Figure 4 Typical images of histopathology and immunohistochemistry staining. (A) Intact epidermis with lesions located in the dermis (HE staining). (B) Tumor cell nests of varying sizes within the dermis (HE staining). (C) Tumor cell nests located within lymphatic vessels, with large cell volume, rich red-stained cytoplasm, and deeply stained large cell nuclei (HE staining, indicated by arrows pointing to lymphatic vessels). (D-F) Strong positive expression of P16 in tumor cells, staining located in the cytoplasm, appearing brownish-yellow (SP method). (G-I) Moderate positive expression of CK5/6 in tumor cells, staining located in the cytoplasm, appearing light yellow (SP method). (J-L) Strong positive expression of P63 in tumor cells, staining located in the cell nuclei, appearing brownish-yellow (SP method). Magnification: A,D,G,J (×20); B,E,H,K (×100); C,F,I,L (×400) (patient 4). HE, hematoxylin-eosin; SP, streptavidin-perosidase.

Treatment and prognosis

Treatment strategies included local excision for isolated lesions, chemotherapy, radiotherapy, immunotherapy, or targeted therapy based on the extent of skin involvement. Follow-up until December 2023 revealed that three patients died 5–6 months after the diagnosis of skin metastasis, while three patients were still alive, with one in remission and two with controlled disease, surviving for 30–72 months (Table 1). Among three died patients, they were accompanied by extensive tumor spread, included right ribs, cervix, peritoneum, etc. However, among three alive patients, tumor metastasis was localized, and the treatment approach was active. Thus, we think that early detection of skin metastases in cervical squamous cell carcinoma is favorable for the prognosis.

Discussion

There are few domestic and foreign reports on skin metastasis from cervical cancer. Using the keywords “Cervical cancer” and “Cutaneous metastasis”, literature published between 2001 and 2023 was searched using Foreign Medical Literature Retrieval Service (FMRS) 2020 and the China National Knowledge Infrastructure. Only one article reporting 5 cases was found, with the rest being case reports. As Table 2 showed, a total of 33 cases with comprehensive data were compiled from the literature (3-21), and combined with the six cases in this study.

Table 2

The clinical characteristics of 33 cases with cervical cancer skin metastasis

No. Year Reference Author Age (years) Initial treatment staging (period) Pathology
type		 Metastasis site Features of skin lesions Conscious symptom Merge transfer Relapse time (months) Treatment Survival time (months)
1 2023 (3) Gociman 36 IV Adenocarcinoma Right lower extremity Purplish-red nodules, papules, pustules Pain The supraclavicular and pelvic and abdominal lymph nodes are extensive Precedes the primary disease Chemotherapy + Bevac + symptomatic 15
2 2023 (4) Dai 33 IV.B Squamous cell carcinoma Scalp, torso Nodules, ulcers – Sternum Meantime Immunotherapy Treatment
3 2022 (5) Liu 68 – Squamous cell carcinoma Vulva, both lower limbs Purplish-red papules, plaques and scales – Local recurrence, liver and peritoneum 372 Radiotherapy + chemotherapy + Bevac 6
4 2022 (6) Yang 54 – Adenocarcinoma Vulva Papules, ulcers Pain Not 24 Abandon treatment 2
37 IB2 Adenocarcinoma Vulva, groin Swelling, papules, plaques, erosions, ulcers Pain Local recurrence and para-aortic lymph nodes 48 Symptomatic treatment –
69 IV Squamous cell carcinoma Both lower limbs, right soles Papules, plaques, ulcers – Local recurrence and parahepatic and abdominal para-aortic lymph nodes 6 Palliative care 1
41 III.B Adenocarcinoma Left groin, left leg Plaques, erosions, ulcers, hyperkeratosis, lymphangitis Itching None, but co-infected 46 Symptomatic management 1
51 – Adenocarcinoma Left thigh Erythema swelling, reticular nodules – Right inguinal lymph node 168 Bevac Treatment
46 – Adenocarcinoma Vulva, thighs Swelling, infiltrative erythema, plaques, eczema-like changes Tenderness and itching Not 24 Treatment is not mentioned Lost to follow up
63 III.B Squamous cell carcinoma Chest wall, abdominal wall Tuber – Not 6 Palliative chemotherapy 3
48 III.B Squamous cell carcinoma Arms, chest wall, thighs Subcutaneous nodules – Lungs, bones Meantime Palliative chemotherapy 2
5 2019 (7) Nakamura 64 IB1 Squamous cell carcinoma Vulva, left femoral area Nodules, erythema Itching Not 48 Chemotherapy + Bevac >25
6 2019 (8) Novice 50 – Adenosquamous cell carcinoma Lower abdominal wall, mons pubis, groin Violaceous papulonodules, ulcerated plaques – None, but co-infected 132 Symptomatic management 1
7 2019 (9) Acharfi 40 – Squamous cell carcinoma Left armpit Tuber – Liver, bone 48 Radiation therapy + chemotherapy >12
8 2017 (10) Zhu 35 – Squamous cell carcinoma Vulva Swelling, papules, nodules, erythema – Not 48 Radiation therapy + chemotherapy Lost to follow up
9 2015 (11) Na 46 III.B Squamous cell carcinoma Scalp Subcutaneous nodules – Brain 8 Radiation therapy + symptomatic 4
48 II.B Squamous cell carcinoma Scalp Subcutaneous nodules – Bones, lungs 15 Surgery + nuclide + symptomatic 5
50 II.A Squamous cell carcinoma, adenocarcinoma Chest wall Subcutaneous nodules – Lungs, bones 14 Surgical resection + chemotherapy + symptomatic Not reached
55 III.B Squamous cell carcinoma Chest wall Subcutaneous nodules – Not 1 Surgical excision + symptomatic Not reached
42 II.B Adenocarcinoma Right abdominal wall, back Subcutaneous nodules Tenderness Lungs, left supraclavicular lymph nodes, right nasal cavity 9 Surgical excision + symptomatic 8
10 2015 (12) Marwah 50 II.B Squamous cell carcinoma Back Nodules, ulcers – Not 12 Surgery + radiotherapy Treatment
11 2013 (13) Basu 60 II.A Squamous cell carcinoma Left lower extremity, groin Subcutaneous nodules – Local recurrence, both lungs 12 Radiation therapy + chemotherapy 7
12 2010 (14) Deka 45 II.A Squamous cell carcinoma Umbilicus Nodules, exudations – Not 6 Radiotherapy is ineffective, surgical resection is recurred, and treatment is refused –
39 II.A Squamous cell carcinoma Vulva Nodules, ulcers, edema – Local recurrence, lung 72 Refusal of treatment –
53 II.B Squamous cell carcinoma Umbilicus Nodules, exudations – Not 4 Chemotherapy 3
44 II.A Squamous cell carcinoma Right lower abdominal wall Subcutaneous nodules, swelling Tenderness Not 70 Chemoradiotherapy Follow-up
13 2010 (15) Agrawal 66 IV.A Adenocarcinoma Perineum, groin Maculopapular rash – Bladder and multiple lymph nodes throughout the body 2 Chemotherapy 6
14 2010 (16) Mehrotra 40 II.A Squamous cell carcinoma Abdominal wall Tuber – Liver, lungs 36 Chemotherapy 2
15 2009 (17) Lee 49 – Small cell carcinoma Perineum Fusion papules – Multiple lymph nodes in the lungs and throughout the body 4 Chemoradiotherapy 2
16 2003 (18) Park 47 I.B Squamous cell carcinoma Scalp Subcutaneous nodules – Pelvic lymph nodes, thoracolumbar pyramid 48 Chemoradiotherapy Treatment
17 2002 (19) Palaia 47 II.B Squamous cell carcinoma Lower abdominal wall, buttocks, lower limbs Swelling, diffuse maculopapular rash Itching Not 5 Palliative chemotherapy >9
18 2001 (20) Tian 35 II.A Squamous cell carcinoma Scalp Erythema, alopecia – Not 12 Abandon treatment Lost to follow up
19 2001 (21) Maheshwari 45 II.B Squamous cell carcinoma Scalp Erythema, nodules Pain Bone 8 Radiotherapy Treatment

Bevac, bevacizumab.

Skin metastasis from visceral malignancies is rare (22). In females, the most common skin metastases are from breast tumors (70%) and melanomas (12%), followed by tumors from the ovaries, head and neck, and lungs (23). The rate of skin metastasis from cervical cancer is extremely low, accounting for 0.01–2% of cervical cancer patients during the same period (15,24,25). According to statistics, among 8,171 cases of cervical cancer treated at the Nantong Skin Disease Research Institute and Nantong Tumor Hospital from January 2010 to June 2023, there were six cases of skin metastasis from cervical squamous cell carcinoma, with no skin metastases from other types such as adenocarcinoma or adenosquamous carcinoma, resulting in skin metastasis rates of 0.07% for cervical cancer and 0.08% for cervical squamous cell carcinoma, consistent with the literature.

Cervical cancer includes cervical squamous cell carcinoma and cervical adenocarcinoma. Yang et al. mentioned that adenocarcinoma and undifferentiated carcinoma are more likely to develop skin metastases than squamous cell carcinoma (6). Among the 33 reported cases of skin metastasis from cervical cancer, 22 cases were squamous cell carcinoma (66.67%), while other types such as adenocarcinoma and adenosquamous carcinoma accounted for 11 cases (33.33%). In this study, all six cases of skin metastasis from cervical cancer were squamous cell carcinoma, possibly due to the higher proportion of squamous cell carcinoma among cervical cancer patients and the lower incidence of adenocarcinoma and other types of tumors. Among the 33 patients, skin metastases from cervical cancer can occur throughout the body’s skin, mostly within 2 years after treatment of stage IB to stage IV cervical cancer, with the longest occurrence being 14 years after initial treatment for cervical cancer. One cervical cancer patient presented with skin metastasis as the initial symptom, and in two cases, skin metastasis was discovered simultaneously with the initial diagnosis of cervical cancer. In our study, the six patients with skin metastases had lesions distributed throughout the body’s skin, occurring within 2 years after treatment of stage IB to stage IIB cervical cancer, which is generally consistent with the literature.

The clinical manifestations of skin metastasis from cervical cancer are diverse. The skin lesions in the 33 cases reported in the literature and the six cases in this study include erythema, nodules, ulceration, and erosion, most of which are asymptomatic. Clinical diagnosis is challenging and requires a combination of histopathology, ancillary tests, and a history of cancer to make a diagnosis. The histopathology of most skin metastases from cervical squamous cell carcinoma shows typical squamous cell carcinoma characteristics. Through hematoxylin-eosin (HE) staining and immunohistochemical examination, and comparison with the primary lesion, the morphology under HE staining is similar to the primary lesion, showing the morphology of squamous cell carcinoma, characterized by nest-like growth of cells, large cell volume, polygonal shape, abundant cytoplasm, large and deeply stained nuclei, and frequent mitotic figures. Immunohistochemistry marks specific squamous cell carcinoma markers, such as CK5/6, P16, P63, and P40, all of which are positive, consistent with skin metastasis originating from cervical squamous cell carcinoma.

Common mechanisms of skin metastasis include direct local spread, retrograde spread via lymphatic obstruction, and hematogenous dissemination (26). The mechanism of skin metastasis from rare cervical squamous cell carcinoma is currently unclear. In this study, skin metastases in two patients were located on the chest wall, and examinations revealed concomitant deep sternal and rib bone metastases, suggesting that deep bone metastases infiltrated locally to adjacent subcutaneous tissues, forming subcutaneous nodular lesions. In one patient, after surgery and chemotherapy, multiple scattered subcutaneous nodular metastatic lesions appeared on the liver, lungs, scalp, and fingers, with the initial cervical squamous cell carcinoma pathology indicating squamous cell carcinoma of the cervix with intravascular tumor emboli. In another patient, facial skin metastasis was accompanied by lung metastases, with the likely mechanism of metastasis being hematogenous spread. In one patient, after surgery and chemotherapy, long-term edema of the left lower limb occurred, with intermittent lymphangitis, gradually leading to scattered nodules on the external genitalia and left lower limb (and foot), which increased in size, accompanied by ulceration and pigmentation. Histopathological examination revealed a large number of tumor cells within the lymphatic vessels, confirming that the mechanism of metastasis in this patient occurred through the lymphatic vessels, consistent with the literature reporting that cervical cancer cells can metastasize in a retrograde manner through the lymphatic vessels (27).

In this study, there was one patient with cervical cancer and pelvic lymph node metastasis who developed a solitary subcutaneous lump on the right lumbar back along with lymph node metastasis in the right inguinal region 6 months after chemotherapy. The mechanism of skin metastasis at this site could be hematogenous spread, lymphatic pathway spread, or related to radiation therapy. Some scholars have found that some breast cancer patients develop skin metastasis within the radiation field after radiotherapy, suggesting that the mechanism of metastasis may be related to local changes in the vascular system within the irradiation area (28-30), leading to the capture, growth, and survival of tumor cells in this area. The main characteristics include skin metastatic lesions typically being limited to the irradiation field and appearing months to years after treatment completion (31-33). However, it has not been proven that radiation increases the rate of metastasis occurrence (32). This patient has similarities with these findings, as the subcutaneous lump on the right lumbar back was located within the original cervical cancer radiation field and appeared 6 months after radiation therapy completion.

Skin metastasis from cervical cancer is a poor prognostic indicator, and patients typically die within months of discovering skin metastases (6). Among the 33 cases retrieved from the literature, survival times could be calculated for 19 cases, with the longest survival time exceeding 25 months. The majority (78.9%, 15/19) had a survival time of ≤8 months, while 3 cases (15.8%, 3/19) survived only 1 month, which is consistent with our results. The length of survival time in patients with skin metastasis from cervical cancer is related to the timing of skin metastasis discovery, the severity of the condition, treatment methods, and sensitivity to treatment. Skin metastasis from cervical cancer often accompanies metastases to other visceral sites, requiring personalized treatment strategies based on recurrent metastatic cervical cancer treatment strategies (34). For patients with multiple lesions or unresectable lesions, options include radiotherapy, chemotherapy, targeted immunotherapy, or combination therapy or participation in clinical trials. For resectable lesions, surgery with or without radiotherapy is the preferred option. In this study, of the six patients, 3 died 5–6 months after the diagnosis of skin metastasis, succumbing to extensive tumor metastasis. The remaining three are still alive (one without evidence of disease, two with controlled tumors); one underwent local excision of the metastatic lesion followed by radiotherapy, while the other two received chemotherapy combined with pembrolizumab immunotherapy. Pembrolizumab is a PD-1/CTLA-4 dual-specificity antibody, the world’s first tumor immunotherapy dual-specificity antibody, and the first immunotherapy drug approved in China for recurrent metastatic cervical cancer (35). The survival of these three patients is significantly longer than reported in the literature, possibly due to early detection, combination therapy, or the inclusion of immunotherapy. In addition to the classic surgical, chemoradiotherapy, immunotherapy, and targeted therapy, we can consider other means to treat metastatic skin cancer in the future. Electrochemical therapy is an emerging anti-tumor technology in recent years, combining the application of chemotherapy and electric pulse (36), can be used to treat skin primary or secondary unresectable tumors, improve the quality of life of patients. Claussen et al. prospectively studied 716 patients with skin primary or secondary tumors, and their pain and ulcers improved significantly after electrochemical treatment (37).

Conclusions

When cervical cancer patients present with subtle signs such as subcutaneous nodules or ulcers, consideration should be given to the possibility of skin metastasis, and prompt pathological biopsy diagnosis and selection of appropriate treatment options are crucial to extend patient survival and improve quality of life in advanced stages. Immunotherapy was proved to have promising results in our case and may be used as the preferred treatment for such patients in the future. With scientific advancements, new drugs or treatment methods are continually being developed to bring new hope to patients with skin metastasis from cervical cancer.

Acknowledgments

Funding: This work was supported by the Special Research Fund for Clinical Medicine of Nantong University (No. 2023JZ029), the Health Committee Science Project of Nantong (No. WB2021045), and the Foundation of Nantong Science and Technology Bureau (No. MS22022015).

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://cco.amegroups.com/article/view/10.21037/cco-24-60/rc

Data Sharing Statement: Available at https://cco.amegroups.com/article/view/10.21037/cco-24-60/dss

Peer Review File: Available at https://cco.amegroups.com/article/view/10.21037/cco-24-60/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-60/coif). All authors report the funding from the Special Research Fund for Clinical Medicine of Nantong University (No. 2023JZ029), the Health Committee Science Project of Nantong (No. WB2021045), and the Foundation of Nantong Science and Technology Bureau (No. MS22022015). The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Ethical clearance was provided by the Ethics Committee of the Affiliated Tumor Hospital of Nantong University (No. 2021-105), and the individual consent for this retrospective analysis was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Cite this article as: Shen Y, Jin X, Zhu Y, He C. Clinical analysis of patients with skin metastasis of cervical squamous cell carcinoma. Chin Clin Oncol 2024;13(3):35. doi: 10.21037/cco-24-60

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