Cutaneous metastasis of invasive ductal carcinoma of the breast to an infusaport site

Cutaneous metastasis of a primary internal malignancy is a relatively common phenomenon, occurring in up to 10% of patients with noncutaneous cancer. Cutaneous metastasis can occur via direct extension, hematologic or lymphatic dissemination, or surgical implantation. The most common internal malignancy associated with the development of cutaneous metastases in females is breast cancer. We present a patient with widely metastatic invasive ductal carcinoma of the breast, status postpalliative mastectomy and chest wall coverage with a vertical rectus abdominus myocutaneous flap, who acquired cellulitis and, subsequently, noncontiguous cutaneous metastasis of her breast cancer to the site of her central venous access device (ie, infusaport). We hypothesize that the local inflammation associated with her recent bout of cellulitis and operations, in conjunction with the presence of a foreign body, may have predisposed the infusaport site to seeding by metastatic tumor cells. This case highlights the importance of considering cutaneous metastasis in the differential diagnosis of new skin eruptions in patients with cancer.     

Cutaneous scrotal metastasis: origins and clinical characteristics of visceral malignancies that metastasize to the scrotum

Cutaneous metastases occur in about 10% of patients with cancer, occasionally presenting as the initial sign of internal malignancy. Most often cutaneous metastases are an indicator of advanced cancer and are associated with a poor prognosis. The scrotum is a rare site of cutaneous metastasis, and metastatic tumor to the scrotum can be mistaken for other skin lesions. We reviewed the published literature regarding patients who developed cutaneous metastasis to the scrotum. We summarized the clinical characteristics of these men, including primary tumor sites, age at diagnosis, treatment regimens, interval between diagnosis of primary tumor and subsequent metastasis, and outcomes. We extensively searched the PubMed medical database for papers on visceral malignancies with metastasis to the scrotum. We limited our definition to solid organ tumors; thus lymphomas, sarcomas, and melanomas of the scrotum were excluded. We identified 29 patients who developed scrotal metastases from visceral cancers. The colon/rectum (34%), prostate (28%), and lung (14%) were the most frequent sites of tumor origin. The prognosis for these patients is poor: mean patient survival was only four months after diagnosis of metastatic skin lesions. Cutaneous metastasis to the scrotum is a rare manifestation of internal malignancies that most often represents an advanced and/or progressive cancer associated with a poor prognosis. Treatment is often unsuccessful, and the mean patient survival following scrotal metastasis is <4 months.     

Cutaneous metastases from non-small cell lung cancer

BACKGROUND: Cutaneous metastases are an uncommon phenomenon that occurs in a few patients with metastatic disease. Early recognition of a cutaneous metastasis is important as it may be the presenting sign of an underlying malignancy. These metastases usually indicate advanced disease and carry a poor prognosis. OBJECTIVES: We present two cases with cutaneous metastasis from primary non-small cell lung cancer. We seek to familiarize dermatologists with the unusual presentations of cutaneous metastases. CONCLUSION: In our two cases, the diagnosis of the metastatic cutaneous lesion ultimately led to the correct diagnosis of an underlying malignancy.     

Cutaneous manifestations of internal malignancy

Background:

Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases) or nonspecific lesions.

Aims:

The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy.

Materials and Methods:

750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC) and marker studies.

Results:

Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93%) patients.

Conclusion:

Cutaneous metastases (specific lesions) were seen in 20 patients (2.66%): contiguous in 6 (0.8%), and non-contiguous in 14 (1.86%). Nonspecific skin changes were seen in 32 patients (4.26%). None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis.     

Cutaneous metastasis of lung carcinoma: a retrospective study of 12 cases

Background The skin is a rare site of metastasis of the internal malignancies. On the contrary, lung cancer is a common primary malignancy of skin metastasis. The latter is either synchronous with the primary lung tumour or can reveal it. Objective To analyse the clinical findings and the outcome of cutaneous metastasis in patients with primary lung cancer. Methods Retrospective study including 12 cases of cutaneous metastasis of lung cancer diagnosed in our institution during 6 years. Results Our patients included three women and nine men with a median age of 59.83 years. The cutaneous metastases were unique in seven cases. They revealed the primary tumour in two cases, were discovered synchronously with the primary tumour in six cases and after the primary tumour in four cases. They appeared in patients presenting multiple metastases in 10 cases. Clinical appearance consisted on a firm nodule, sometimes ulcerated with a diameter ranging from 0.5 to 5.5 cm. The tumour was sited in the thorax, the back, the abdomen; or the upper or lower limbs. Pathological examination of bronchial biopsy revealed an adenocarcinoma in eight cases, a squamous cell carcinoma in two cases and a small cell carcinoma in two cases. In spite of lung cancer therapies, the patients with metastasis to other organs with a median follow‐up time of 4 months died. Conclusion Cutaneous metastases of lung cancer are of poor prognosis. They are most of the time associated with an advanced neoplastic process with metastasis to other organs. Median survival after skin involvement does not exceed months.     

Cutaneous metastasis: a clinical, pathological, and immunohistochemical appraisal

BACKGROUND: Cutaneous tumor metastasis may be the first manifestation of cancer, but more often is a harbinger of advanced disease that portends an ominous prognosis. All skin accessions over the past 10 years from a large Veterans Administration (VA) hospital were reviewed. METHODS: Archived histories, glass slides, and the immunohistochemical battery (IHC), were assessed to determine diagnostic accuracy. RESULTS: Of the 100,453 cases reviewed, there were a total of 77 cases (75 males and 2 females) of cutaneous metastasis from the lungs (28.6%), metastatic melanoma (18.2%), gastrointestinal tract (14.2%), genitourinary tract (10.4%), head and neck (9.1%), hematologic (5.2%), breast (5.2%), and miscellaneous (<2%). Metastasis represented the first indication of an internal malignancy in 7.8% of cases. The cutaneous sites of involvement included the head and neck (28%), the trunk (40%), the extremities (18%), and multiple sites (14%). The age range was 38-83 years, with a mean of 62 years. The average time interval between diagnosis of internal malignancy and cutaneous presentation was 33 months (range: <1 month-22 years), and the average survival following diagnosis was 7.5 months (range: <1 month-8 years). In a cohort of subjects, a truncated immunohistochemical battery consisting of CK-7, CK-20, and S-100 was consistent with the expected staining pattern of the primary source of cutaneous metastasis in 83.33% of the patients. CONCLUSIONS: Excluding the potential for age and gender bias in this study conducted in a VA setting, cutaneous metastases represent an uncommon, deadly, and late-developing occurrence in many patients. Compared with previous studies, lung carcinoma remains the most common of the cutaneous metastases, with a relative rise in the incidence of metastatic melanoma. The immunohistochemical battery of CK-7, CK-20, and S-100 is a helpful adjunct in narrowing the differential diagnosis of the primary site of a large proportion of cutaneous metastases, particularly tumors with an epithelioid appearance such as carcinomas and melanomas.     

Skin metastases of malignant melanoma clinically simulating folliculitis

Cutaneous metastases of malignant melanoma were seen as small red papules with central hair resembling the typical clinical picture of folliculitis. This type of cutaneous metastasis was observed in a 51-year-old woman 12 months and in a 42-year-old man 30 months after wide excision of cutaneous malignant melanoma, in both cases located on the lower extremity. The first case presented a reflux metastasis, the second case a hematogenous metastasis on the contralateral thigh. Histological findings concurrently revealed metastases of malignant melanoma located at the cutaneous-subcutaneous interface beneath the hair follicle. This type of cutaneous metastasis could be easily excised in toto by means of a 6 mm diameter punch biopsy.     

Cutaneous metastatic cholangiocarcinoma: a report of three cases and review of the literature

Cutaneous metastasis from cholangiocarcinoma is an extremely rare event. Herein, we present three cases with review of the literature. Case 1 is that of a young female with scalp metastasis. Cases 2 and 3 involve cutaneous metastasis to the sites of prior biliary drains, one occurring in a young female with a history of multiple biliary surgeries and one in a male with a history of sclerosing cholangitis. Review of the literature shows that the presentation of cutaneous metastases from cholangiocarcinoma can vary in terms of anatomic location and clinical features. The pathological and immunohistochemical profile of metastatic cholangiocarcinoma can be non-specific, and accurate diagnosis relies in part on clinical correlation. In summary, metastatic disease should always be included in the differential diagnosis of cutaneous lesions in patients with known malignancy.     

Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal

Background Cutaneous metastases are perceived as a sign of advanced disease and are regarded as a grave prognostic indicator. In addition, few reports have focused on the cutaneous metastasis profiles of Asian patients. Objectives We seek to analyse the clinical and prognostic characteristics of cutaneous tumour metastases in a Taiwanese medical centre. Methods Clinical records from Kaohsiung Medical University Hospital over the last 20 years (1986–2006) were reviewed, and cases of biopsy‐proven cutaneous metastases from internal malignancies identified. Survival rates were evaluated using the Kaplan‐Meier method and compared by the log‐rank test. The Cox proportional hazards model was used for univariate analysis to determine the risk of mortality among different groups. Results A total of 141 cases of cutaneous metastases were identified. The clinical profiles were similar to those from western countries, although the frequencies of primary tumours were different. The duration of survival was usually short following diagnosis of cutaneous metastases, but prognosis is significantly better in breast cancer patients with metastases. Moreover, the survival was even longer for breast cancer patients when the metastasis was confined to the skin. Conclusions The risk of skin metastases depends largely on the characteristics of tumour cells, which is similar among different ethnic groups. In terms of prognosis, a subset of breast cancer patients has superior prognosis, even among breast cancer patients with stage IV disease. Physicians should consider this finding in clinical situations to avoid possible misinformation about the prognosis of the disease.     

Cutaneous metastasis: clinicopathological study of 72 patients from a tertiary care center in Lebanon

Background Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. Objective To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut – Medical Center (AUB‐MC) and to compare our findings with those published in the literature. Methods Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB‐MC between 1992 and 2010. Results A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). Conclusion This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences.     

皮肤转移癌的临床分析

目的：研究临床较少见的恶性肿瘤皮肤转移患者的临床表现及治疗预后。方法：采用临床资料的回顾分析方法，分析恶性肿瘤皮肤转移主要临床表现、病理分类、原发癌肿部位和接受治疗情况及生存时间等。结果：皮肤转移首发多在躯干，以多发结节肿块型为主；皮肤转移发现时有其他脏器转移者29例。病理以低分化癌(21／51)、腺癌(23／51)多见。51例中位生存期8个月，接受治疗者10个月。近期治疗效果未分化癌好，低分化癌生存期长。原发乳腺癌生存时间最长，肝癌最短。结论：皮肤转移为恶性肿瘤多脏器转移之一，预后差。合理有效的综合治疗仍可减轻症状、延长生存期、提高生活质量。     

Metástasis cutáneas de tumores sólidos. Estudio descriptivo retrospectivo

Introduction

Cutaneous metastases are a rare event compared with other metastases. Their incidence is estimated between 0.7% and 9% of patients with cancer. Their presence always indicates a disseminated malignant disease and could also be the first manifestation of a tumor, appearing simultaneously or after a diagnosis of cancer.

Objectives

To describe the epidemiological and clinical characteristics of cutaneous metastases in our hospital.

Material and method

We performed an observational retrospective study. We included all patients with cutaneous metastases diagnosed in the Dermatology Service of our hospital during a 7-year period. Patients with metastases from sarcomas, melanomas and hematologic malignances were excluded.

Results

We studied 102 patients with cutaneous metastases. The primary tumor was identified in 87 patients (85%). The most frequent tumors were breast cancer in women (48%) and lung cancer in men (11%). Cutaneous metastases were the first sign of malignancy in 12 patients (11%). The predominant clinical form was the nodular form. The most common localization of the metastases was the thoracic region. The most common histologic diagnosis was adenocarcinoma. The mean survival after the development of metastases was 22.1 months.

Conclusion

There is an association between the frequency of cutaneous metastases and the most frequent malignancies in each sex.Our results were similar to those of other studies regarding age, sex distribution, the predominant clinical form, location, and histological diagnosis of cutaneous metastases.     

Scalp Ulcer as First Sign of Cholangiocarcinoma

Metastases from distant primary tumors are rarely the first indicators of cancer. However, cutaneous metastases are not uncommon in cases of internal malignancy. This article describes the case of a 65-year-old man with cutaneous metastasis of cholangiocarcinoma who presented with a scalp ulcer as the only initial sign. This is only the third reported case of cholangiocarcinoma with distant cutaneous metastasis.     

Epidermodysplasia verruciformis.--Report of a case and genetic consideration on the Japanese cases.

Thirty three Japanese cases recorded in the last 10 years are reviewed with an additional case of a 57-year-old Japanese woman with typical eruptions and cutaneous malignancies. Familial occurrence and parental consanguinity were seen in at least 30.0% and 26.7% of the cases respectively, further suggesting the recessive mode of inheritance which affects males and females almost equally. Cutaneous malignancy was seen in 48.5% of these patients with an average age of 35.3 yrs.     

Cutaneous Malignancies Mimicking Herpes Zoster

Cutaneous metastases occur in 2.5% to 5% of patients with malignant disease. The relative frequency of the primary site roughly parallels the frequency of the various malignancies in each sex. We present two cases of cutaneous malignancy occurring in a dermatomal distribution and masquerading as herpes zoster. The differential diagnosis of zosteriform eruptions is reviewed and the possible pathogenesis of metastatic disease in this cutaneous distribution is discussed. Skin biopsy is recommended in these cases to determine the etiology of the eruption.     

Cutaneous metastasis of hepatocellular carcinoma following liver transplantation

Cutaneous metastases from hepatocellular carcinoma (HCC) are extremely rare and can represent a sign of an underlying malignancy or relapse/progression from an existing tumor. We report a case of a cutaneous metastasis arising in a patient with metastatic HCC following orthotopic liver transplantation. Diagnosis is a multistep process as cutaneous HCC metastases must be differentiated from primary cutaneous malignancies as well as other cutaneous metastases. Making this even more challenging, HCC metastases have heterogeneous clinical and histologic appearances. Therefore, the use of immunohistochemical stains, including hepatocyte paraffin-1, arginase-1, and glypican-3, and correlation with the clinical context are essential for a correct diagnosis.     

Cutaneous metastases from follicular thyroid carcinoma: histology, immunohistology, and electron microscopy. A report of two cases.

Cutaneous metastases from thyroid carcinoma are extremely rare. We report 2 cases of skin metastases from a follicular thyroid carcinoma. A 53-year-old female patient underwent subtotal thyroidectomy because of the clinical suspicion of malignancy. Histological examination of the resected tissue did not clearly prove malignant features. Eight years later a cutaneous metastasis erupted next to the operation site at the neck. A 66-year-old female patient noticed a growing solitary skin nodule in the occipitoparietal region of her scalp 2 years before a follicular thyroid carcinoma was detected.     

Localized blanching erythema in a patient with vulvar carcinoma

Mammary-like carcinoma arising in the vulva is a rare type of vulvar malignancy. Cutaneous metastasis of vulvar carcinoma is uncommon and the majority of cases have been reported in patients with squamous cell carcinoma of the vulva. We describe a 69-year-old woman with mammary-like carcinoma of the vulva with cutaneous metastasis presenting as asymptomatic localized blanching erythema.     

CUTANEOUS PANCREATIC METASTASIS: A CASE REPORT AND REVIEW OF LITERATURE

Pancreatic cancer is one of the most dangerous human cancers and will continue to be a major unsolved health problem as we enter the 21^st century. This is the case despite advances in imaging technology and surgical management. Indeed, 80% to 90% of pancreatic cancers are diagnosed either at the locally advanced or metastatic stage. Cutaneous metastases originating from pancreatic cancer are relatively rare. The most common site of cutaneous metastasis is the umbilicus, and this is known as the Sister Joseph''s nodule. Very few patients have been reported with cutaneous lesions disclosing a pancreatic carcinoma at sites other than the umbilical area. To the best of our knowledge, there have been no previous reports on cutaneous pancreatic metastasis in Egypt. This is a report on a patient with cutaneous pancreatic metastases at the neck and review of reported non-umbilical cutaneous metastases from pancreatic carcinoma in the literatures.     

Cutaneous squamous cell carcinoma of the lower limbs in Goiânia, Goiás, Brazil

BACKGROUND: Cutaneous squamous cell carcinoma is a common malignant neoplasm that affects areas that are exposed to the sun in fair-skinned people. It occurs less frequently on the lower limbs where other etiological factors are involved. OBJECTIVE: To determine the epidemiological aspects of cutaneous squamous cell carcinoma of the lower limbs in Goiania. METHODOLOGY: Forty-three cases of cutaneous squamous cell carcinoma of the lower limbs from the Cancer Registry of the Population Base of Goiás, for the period between 1995 and 1999, were included in the study. RESULTS: Among the cases of cutaneous squamous cell carcinoma registered in this 5-year interval, 43 (4.6%) represented cases affecting the lower limbs. Of these individuals, seven (16.3%) were male and 36 (83.7%) female (P < 0.001). Those in the age group of 60 years and above represented 90.7% of the cases (P < 0.001). None of the patients had metastasis. CONCLUSION: Cutaneous squamous cell carcinomas on the lower limbs are more frequently seen in women older than 60 years of age, and they rarely metastasize.