Squamous cell carcinoma with pulmonary metastases in a young adult

A 46-year-old patient presents at our outpatient clinic with redness and swelling of the left forearm (Fig. 1.). He has had the skin changes for a few days and feels weak. In addition to this finding on the forearm, a full-body examination revealed two large ulcerations on the left shoulder and left pectoral area (Fig. 2a, b). Approximately 20 years ago, a "hemangioma" had been diagnosed at each of these two sites, but they had not been treated, in particular with radiation. The current findings had been progressive for several years.