Digital necrosis associated with squamous cell carcinoma of the tonsil

BACKGROUND: Digital necrosis is an uncommon paraneoplastic syndrome. Fewer than 50 cases have been sporadically reported through the literature over the last 30 years. CASE REPORT: We describe the unfortunate case of a 62-year-old woman with a locally advanced squamous cell carcinoma of the tonsil. She was admitted to the hospital for symptomatic hypercalcemia and was found to have metastatic disease. She subsequently had digital necrosis develop. Despite numerous attempts to control the rapidly progressive ischemia, little objective evidence of response was noted. Her primary disease did not respond to palliative radiation, and her general condition rapidly deteriorated. CONCLUSIONS: A review of the literature provided some insight into the possible etiology of this unique complication of malignancy. Unfortunately, the treatment options suggested were of limited value, because there was no discernible benefit with any directed treatment. A brief summary and discussion of the literature follows.