Influence of trauma on the unusual distribution of metastases from carcinoma of the larynx

A patient is described with carcinoma of the larynx, locally irradiated and “cured” without evidence of distant metastases. Concomitant with the radiation treatment, he sustained trauma to certain areas of the body as a result of the application of a spica cast and crutch ambulation. Subsequently, metastases developed in areas of the skin, bone, and lymph nodes which had been previously traumatized. The unusual distribution of metastases is discussed with respect to the role of trauma in determining the localization of metastatic lesions, and the implications of the delay in the appearance of metastases following “cure” of a primary lesion are considered.