Patient With Supraglottic Squamous Cell Carcinoma Develops Painful Swelling on Both Great Toes


A 49-year-old woman with a 150 pack-year history of smoking, was being treated with cetuximab plus radiotherapy as management for recurrent supraglottic squamous cell carcinoma. Her tumor had previously been treated by surgical intervention alone. The patient tolerated her first 5 cycles of therapy without incident, but following cycle 6 she began to develop painful, erythematous swelling on both great toes. Past medical history did not disclose ingrown toenails as a prior problem.

Which statement is true regarding her present foot malady?

A. This most likely represents bilateral ingrown toenails unrelated to her treatment.
B. This most likely represents a reaction related to her specific type of treatment.
C. This most likely is a fungal infection. Hospitalization and intravenous amphotericin-B are indicated.
D. This pattern strongly suggests squamous cell carcinoma metastatic to the toes.