Humoral Hypercalcemia
The second most common cause of hypercalcemia is humoral hypercalcemia of malignancy (HHM), a condition associated with increased mortality. Although hypercalcemia is usually seen in squamous cell cancers, only 13 cases have been described in association with squamous cell skin cancer, and only 5 of these had characteristics of HHM. We report a case of hypercalcemia due to squamous cell skin cancer confined to the chest wall in a 67-year-old semi-comatose patient. Aggressive treatment with intravenous fluid hydration, furosemide, and etidronate corrected the hypercalcemia. A thorough workup ruled out bone metastasis and confirmed increased parathyroid-related protein, the hallmark of HHM. After regaining consciousness, the patient refused further therapy and subsequently died.
Hypercalcemia can be a sign of serious disease. Hyperparathyroidism is the most common cause of hypercalcemia, followed by malignancy; up to 58% of hospitalized patients with hypercalcemia have an associated cancer.
Malignancy-associated hypercalcemia can be caused by two entities, separately or in combination, based on the mechanisms of hypercalcemia. Humoral hypercalcemia of malignancy (HHM) is due to tumor hormone secretion into the systemic circulation distant to the skeleton with subsequent bone resorption. Local osteolytic hypercalcemia is caused by osteoclastic bone resorption from the release of factors produced by direct skeletal tumor involvement.
Squamous cell carcinomas account for approximately 50% of cases of HHM. Most cases involve the lung, but carcinomas of the head and neck, oropharynx, and urogenital region have been described. Squamous cell carcinoma of the skin with HHM is unusual. To our knowledge, 13 case reports in the literature have associated both. The remaining cases of HHM have been seen in renal cortical carcinoma, adult T-cell leukemia, and breast, colorectal, and esophageal adenocarcinoma.
The second most common cause of hypercalcemia is humoral hypercalcemia of malignancy (HHM), a condition associated with increased mortality. Although hypercalcemia is usually seen in squamous cell cancers, only 13 cases have been described in association with squamous cell skin cancer, and only 5 of these had characteristics of HHM. We report a case of hypercalcemia due to squamous cell skin cancer confined to the chest wall in a 67-year-old semi-comatose patient. Aggressive treatment with intravenous fluid hydration, furosemide, and etidronate corrected the hypercalcemia. A thorough workup ruled out bone metastasis and confirmed increased parathyroid-related protein, the hallmark of HHM. After regaining consciousness, the patient refused further therapy and subsequently died.
Hypercalcemia can be a sign of serious disease. Hyperparathyroidism is the most common cause of hypercalcemia, followed by malignancy; up to 58% of hospitalized patients with hypercalcemia have an associated cancer.
Malignancy-associated hypercalcemia can be caused by two entities, separately or in combination, based on the mechanisms of hypercalcemia. Humoral hypercalcemia of malignancy (HHM) is due to tumor hormone secretion into the systemic circulation distant to the skeleton with subsequent bone resorption. Local osteolytic hypercalcemia is caused by osteoclastic bone resorption from the release of factors produced by direct skeletal tumor involvement.
Squamous cell carcinomas account for approximately 50% of cases of HHM. Most cases involve the lung, but carcinomas of the head and neck, oropharynx, and urogenital region have been described. Squamous cell carcinoma of the skin with HHM is unusual. To our knowledge, 13 case reports in the literature have associated both. The remaining cases of HHM have been seen in renal cortical carcinoma, adult T-cell leukemia, and breast, colorectal, and esophageal adenocarcinoma.