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1. Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil. 2. Hospital Casa de Portugal – 3D Diagnose, Rio de Janeiro, RJ, Brazil. 3. Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. Mailing address: Dr. Bruno Niemeyer de Freitas Ribeiro. Instituto Estadual do Cérebro Paulo Niemeyer – Departamento de Radiologia. Rua do Rezende, 156, Centro. Rio de Janeiro, RJ, Brazil, 20231-092. E-mail: bruno.niemeyer@hotmail.com. The frequency of metastases to the skin is rare, ranging from 0.7% to 9%, such metastases occurring mainly in advanced-stage lung and breast cancers, predominantly affecting the scalp, neck, forearm, thigh, or penis. To our knowledge, there have been no studies discussing the imaging characteristics of squamous cell carcinoma metastases to the skin. In the case presented here, the lesions were similar to the primary tumor, with hypointense signals in T1-weighted sequences and isointense or hypointense signals in T2-weighted sequences, as well as heterogeneous gadolinium enhancement and restricted diffusion. Recent studies highlight the use of diffusion-weighted sequences in the evaluation of head and neck lesions, showing that apparent diffusion coefficient values below 1.22 × 10 mm/s are suggestive of malignancy. In our case, the apparent diffusion coefficient value was 0.78 × 10 mm/s, thus corroborating those previous findings. The differential diagnosis of cutaneous lesions is extensive, including hemangiomas, pilomatrixomas, tuberculosis, leishmaniasis, lymphomas, and sarcomas. Although imaging methods can help in distinguishing among the causes, the diagnosis in typically made through histopathological analysis. Cutaneous metastases are uncommon and do not present specific imaging characteristics. They should nevertheless be considered among the diagnostic possibilities in cases of cutaneous lesions, particularly when there is a known history of neoplasia. REFERENCES

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