Are squamous cell carcinoma metastases typically firm and woody?

Squamous Cell Carcinoma Metastases: Texture and Consistency

Squamous cell carcinoma metastases, particularly to lymph nodes, are typically firm and may feel indurated or "woody" on palpation, especially when there is extracapsular spread or a desmoplastic stromal response.

Clinical Characteristics of Metastatic Lymph Nodes

Palpable Features

• Metastatic lymph nodes from squamous cell carcinoma present as firm, enlarged nodes on physical examination 1
• Nodes that become palpable during follow-up after initially being non-palpable are malignant in nearly 100% of cases 1
• At initial diagnosis, approximately half of palpable inguinal nodes are enlarged due to inflammatory changes rather than malignancy, but persistent or newly appearing nodes are highly suspicious 1

Histopathologic Correlates

• The firm or "woody" texture correlates with specific pathologic features, particularly when extracapsular spread is present with an associated reactive stromal response 1
• Desmoplastic squamous cell carcinoma, which is characterized by extensive stromal fibrosis, poses greatly increased risk of both recurrence and metastasis and would present with particularly firm consistency 2
• Perineural invasion, which significantly increases metastatic risk, may contribute to the indurated quality of metastatic deposits 2, 3

Distinguishing Features by Metastatic Burden

Macrometastases

• Larger metastatic deposits demonstrate more pronounced firmness on examination 1
• The presence of extracapsular spread—where tumor extends beyond the lymph node capsule—creates a particularly firm, fixed quality to the node 1

Micrometastases and Isolated Tumor Cells

• Smaller deposits (micrometastases 0.2-2mm or isolated tumor cells <0.2mm) may not produce palpable changes in nodal consistency 1
• These require histopathologic examination with serial sectioning and immunohistochemistry for detection 1

Clinical Implications

Physical Examination Technique

• Physical examination should record both morphological and physical characteristics of suspicious nodes, specifically documenting firmness, fixation, and size 1
• Firm, fixed nodes warrant fine-needle aspiration cytology (FNAC) biopsy for confirmation 1

High-Risk Primary Tumor Features Associated with Nodal Metastases

• Rapidly growing primary tumors indicate high-risk behavior with increased metastasis risk and correlate with firmer metastatic deposits 2
• Poorly defined or ill-defined tumor borders in the primary lesion predict nodal involvement 2
• Invasion into deep reticular dermis or subcutaneous fat (Clark level IV or V) associates with aggressive behavior and nodal spread 2
• Perineural involvement significantly increases risk of firm, infiltrative metastases 2, 3

Important Caveats

• Not all firm lymph nodes represent metastatic disease—inflammatory adenopathy can also present with firmness, particularly in the acute setting 1
• A 4-6 week course of antibiotics may be warranted before biopsy if infection is suspected, though repeat biopsy or node excision is advised if nodes remain enlarged 1
• The "woody" quality is most pronounced with extracapsular extension and desmoplastic stromal reaction, which carry worse prognosis 1, 2