BACKGROUND: Spinal leptomeningeal carcinomatosis from a cutaneous squamous cell carcinoma
(SCC) origin is exceedingly rare. Herein, we describe the first report of cauda equina syndrome
secondary to drop metastases from a skin SCC. CASE DESCRIPTION: A 69-year-old male with a history of recurrent SCC of the face with known
cranial nerve involvement presented with acute onset sphincter and lower extremity
symptoms. Neuroimaging revealed a compressive intradural mass at the lumbosacral junction.
The patient underwent urgent surgical decompression followed by adjuvant fractionated
radiotherapy. Substantial improvement in function and quality of life was reported on
postoperative follow-up. CONCLUSION: Cauda equina syndrome manifestations in a patient with a history of cutaneous SCC with perineural spread should raise suspicion for drop metastases. In this case, a relatively
straight forward surgical procedure resulted in significant improvement in the quality of life.
Therefore, operative intervention should be considered to prevent permanent neurological
deficits depending on the patient’s goals of care and overall clinical status
