| Summary points: | A 62-year-old man presents with a 3-month history of an ulcerative lesion on his left tonsil. He had noticed left-sided cervical adenopathy in the preceding 2 months. He first noticed a left axillary mass 6 weeks before presentation. Clinical examination, chest x-ray, computed tomography of the chest, examination of his abdomen and musculoskeletal system, laboratory data, and histology from the oropharyngeal primary tumour are described. The authors describe the first reported incidence where the axillary nodes are involved in the primary presentation of a patient presenting with squamous cell carcinoma of the upper aerodigestive system. |