Introduction
Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer, and they usually originate from malignant melanoma ¹. Various types of pulmonary cancer lead to cutaneous metastases in 1.5 to 2.6% of cases ². In this report, we describe an unusual case of small-cell lung cancer metastasizing to his face at the time of initial diagnosis.

Case presentation
A 64-year-old man, a heavy smoker, was referred to our department with a short history of dyspnea, pleuritic pain and loss of weight, as well as a painful nodule on his left cheek which was noticed almost simultaneously with the principal symptoms. His general condition was good, although he suffered from coronary artery disease and diabetes mellitus type II. A chest X-ray revealed a left upper lobe mass with mediastinal lymphadenopathy without pleural effusion. Bronchoscopy revealed no evidence of malignancy, and bronchial biopsy and washings also proved negative for malignant cells. In order to perform pre-operative staging of the tumour, the patient underwent computed tomography (CT) scans of brain and abdomen, and a bone scan. All had normal results.