Abstract
Background
Cutaneous metastases represent 2% of all skin tumours. Their recognition can be challenging, as they may present with different clinical features, with consequent frequent delay and failure in diagnosis.
Objectives
To review our series of cutaneous metastatic lesions, analyse their frequency according to patient gender, histotype, localization of the primary tumour, and site of cutaneous metastasis, and correlate this data with clinicopathological parameters.
Materials & methods
We conducted a retrospective review of all cases of cutaneous metastases from visceral neoplasms diagnosed in our dermatopathology department from July 2003 to February 2017. We registered clinical, histological, and immunohistochemical data. Additional immunohistochemical staining panels were elaborated to confirm or identify the origin of the primary tumour, or at least to specify the histological subtype.
Results
We identified 45 histological diagnoses of cutaneous and mucocutaneous metastases. The primary tumour that was most likely to metastasize to the skin was breast cancer. Most cases of breast (89%) and lung cancer (86%) metastasized to the trunk. Of the lesions, 57.5% were nodules and 32.5% were plaques, more frequently multiple (64.4%). In 58% of cases, a metastasis was clinically suspected. Histological examination most frequently revealed an adenocarcinoma, sometimes suggestive of the site of origin.
Conclusions
Cutaneous metastases should be primarily considered when discrete firm painless nodules emerge rapidly. Clinicians should carefully consider infiltrated lesions of the chest in women since scleroderma and erysipelas-like presentation can be a clue for undiagnosed breast cancer.
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References
Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma: a retrospective study of 7316 cancer patients. J Am Acad Dermatol 1990; 22: 19–26.
Schwartz RA. Cutaneous metastatic disease. J Am Acad Dermatol 1995; 33: 161–85.
Spencer PS, Helm TN. Skin metastases in cancer patients. Cutis 1987; 39: 119–21.
Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol 1993; 29: 228–36.
Brownstein MH, Helwig EB. Metastatic tumor of the skin. Cancer 1972; 29: 1298–307.
Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: a metaanalysis of data. South Med J 2003; 96: 164–7.
Reingold IM. Cutaneous metastases from internal carcinoma. Cancer 1966; 19: 162–8.
Brownstein MH, Helwig EB. Patterns of cutaneous metastasis. Arch Dermatol 1972; 105: 862–8.
Alcaraz I, Cerroni L, Rütten A, Kutzner H, Requena L. Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol 2012; 34: 347–93.
Paolino G, Panetta C, Didona D, Donati M, Donati P. Folliculotropic cutaneous metastases and lymphangitis carcinomatosa: when cutaneous metastases of breast carcinoma are mistaken for cutaneous infections. Acta Dermatovenerol Croat 2016; 24: 154–7.
Navaratnam AV, Chandrasekharan S. Remote cutaneous breast carcinoma metastasis mimicking dermatitis. Indian J Dermatol 2015; 60: 106.
Saeed S, Keehn CA, Morgan MB. Cutaneous metastases: a clinical, pathological and immunohistochemical appraisal. J Cutan Pathol 1994; 31: 419–30.
Fernández-Antón Martínez MC, Parra-Blanco V, Avilés Izquierdo JA, Suárez Fernández RM. Cutaneous metastases of internal tumors. Actas Dermosifiliogr 2013; 104: 841–53.
Fernandez-Flores A. Cutaneous metastases: a study of 78 biopsies from 69 patients. Am J Dermatopathol 2010; 32: 222–39.
Nashan D, Meiss F, Braun-Falco M, et al. Cutaneous metastases from internal malignancies. Dermatol Therapy 2010; 23: 567–80.
De Giorgi V, Grazzini M, Alfaioli B, et al. Cutaneous manifestations of breast carcinoma. Dermatol Ther 2010; 23: 581–9.
Hu SC, Chen GS, Lu YW, Wu CS, Lan CC. Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal. J Eur Acad Dermatol Venereol 2008; 22: 735–40.
Virmani NC, Sharma YK, Panicker NK, Dash KN, Patvekar MA, Deo KS. Zosteriform skin metastases: clue to an undiagnosed breast cancer. Indian J Dermatol 2011; 56: 726–7.
Abdeen Y, Amireh S, Patel A, Al-Halawani M, Shaaban H, Miller R. Cutaneous metastasis as a first presentation for lung adenocarcinoma. N Am J Med Sci 2016; 8: 222–5.
Hwang SK, Chen Z, Sun Q, Pan R, Pang MH. Cutaneous metastasis of breast cancer previously diagnosed 25 years ago. Chin Med J (Engl) 2014; 127: 1000.
Oliveira GM, Zachetti DB, Barros HR, Tiengo A, Romiti N. Breast carcinoma en Cuirasse-case report. An Bras Dermatol 2013; 88: 608–10.
Terashima T, Kanazawa M. Lung cancer with skin metastasis. Chest 1994; 106: 1448–50.
Kauffman CL, Sina B. Metastatic inflammatory carcinoma of the rectum: tumor spread by three routes. Am J Dermatopathol 1997; 19: 528–32.
Fiori E, Galati G, Bononi M, et al. Subcutaneous metastasis of pancreatic cancer in the site of percutaneous biliary drainage. J Exp Clin Cancer Res 2003; 22: 151–4.
Pontinen T, Melin A, Varadi G, et al. Cutaneous metastasis of pancreatic adenocarcinoma after kidney transplant: a case report and review of the literature. Exp Clin Transplant 2010; 8: 273–6.
Siriwardena A, Samarji WN. Cutaneous tumour seeding from a previously undiagnosed pancreatic carcinoma after laparoscopic cholecystectomy. Ann R Coll Surg Engl 1993; 75: 199–200.
Bergenfeldt M, Genell S, Lindholm K, Ekberg O, Aspelin P. Needle-tract seeding after percutaneous fine-needle biopsy of pancreatic carcinoma. Case Report Acta Chir Scand 1988; 154: 77–9.
Reuter MJ, Nomland R. Inflammatory cutaneous metastatic carcinoma. Wis Med J 1941; 40: 196–201.
Edelstein JM. Pancreatic carcinoma with unusual metastasis to the skin and subcutaneous tissue simulating cellulitis. N Engl J Med 1950; 242: 779–81.
Schwartz RA, Rubenstein DJ, Raventos A, et al. Inflammatory metastatic carcinoma of the parotid. Arch Dermatol 1984; 120: 796–7.
Handa U, Kundu R, Dimri K. Cutaneous metastasis: a study of 138 cases diagnosed by fine-needle aspiration cytology. Acta Cytol 2017; 61: 47–54.
Sittart JA, Senise M. Cutaneous metastasis from internal carcinomas: a review of 45 years. An Bras Dermatol 2013; 88: 541–4.
Gül U, Kiliç A, Gönül M, Külcü Cakmak S, Erinçkan C. Spectrum of cutaneous metastases in 1287 cases of internal malignancies: a study from Turkey. Acta Derm Venereol 2007; 87: 160–2.
Itin P, Tomaschett S. Cutaneous metastases from malignancies which do not originate from the skin. An epidemiological study. Internist (Berl) 2009; 50: 179–86.
Hu SC, Chen GS, Wu CS, Chai CY, Chen WT, Lan CC. Rates of cutaneous metastases from different internal malignancies: experience from a Taiwanese medical center. J Am Acad Dermatol 2009; 60: 379–87.
Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer 1950; 3: 74–85.
Mehregan AH. Metastatic carcinoma to the skin. Dermatologica 1961; 123: 311–25.
Gates O. Cutaneous metastases of malignant disease. Am J Cancer 1937; 30: 718–30.
Wong CY, Helm MA, Kalb RE, Helm TN, Zeitouni NC. The presentation, pathology, and current management strategies of cutaneous metastasis. N Am J Med Sci 2013; 5: 499–504.
Nebesio CL, Goulet RJ Jr., Helft PR, et al. Metastatic esophageal carcinoma masquerading as inflammatory breast carcinoma. Int J Dermatol 2007; 46: 303–5.
Schonmann R, Altaras M, Biron T, et al. Inflammatory skin metastasis from ovarian carcinoma-a case report and review of the literature. Gynecol Oncol 2003; 90: 670–2.
Mullinax K, Cohen JB. Carcinoma en cuirasse presenting as keloid of the chest. Dermatol Surg 2004; 30: 226–8.
Ingram JT. Carcinoma erysipelatoides and carcinoma telangiectaticum. AMA Arch Dermatol 1958; 77: 227–31.
Pastner B, Mann WJ, Chumas J, et al. Herpetiform cutaneous metastases following negative second look laparotomy for ovarian adenocarcinoma. Arch Gynecol Obstet 1988; 244: 63–8.
Delacretas J, Chapuis H. Metastases cutanees alopeciantes. Dermatologica 1958; 116: 372–3.
Sabater V, Ferrando F, Morera A, Palomar L. Cutaneous metastasis of inflammatory breast carcinoma mimicking an erythema annulare centrifugum: a sign of locally recurrent cancer. Clin Exp Dermatol 2016; 41: 906–10.
Matsuoka LY. Neoplastic erythema nodosum. J Am Acad Dermatol 1995; 32: 361–3.
Pickard C, Callen JP, Blumenreich M. Metastatic carcinoma of the breast. An unusual presentation mimicking cutaneous vasculitis. Cancer 1987; 59: 1184–6.
Shamai-Lubovitz O, Rothem A, Ben-David E, et al. Cutaneous metastatic carcinoma of the breast mimicking malignant melanoma, clinically and histologically. J Am Acad Dermatol 1994; 31: 1058–60.
Hager CM, Cohen PR. Cutaneous lesions of metastatic visceral malignancy mimicking pyogenic granuloma. Cancer Invest 1999; 17: 385–90.
Batres E, Knox JM, Wolf JE Jr. Metastatic renal cell carcinoma resembling a pyogenic granuloma. Arch Dermatol 1978; 114: 1082–3.
Lalich D, Tawfik O, Chapman J, et al. Cutaneous metastasis of ovarian carcinoma with shadow cells mimicking a primary pilomatricomal neoplasm. Am J Dermatopathol 2010; 32: 500–4.
Cho YH, Park SG, Kim SH, et al. Cutaneous metastatic malignant mixed Mullerian tumor mimicking cutaneous leiomyosarcoma: a case report. Br J Dermatol 2004; 151: 947–9.
Franzblau MJ, Manwaring M, Plumhof C, et al. Metastatic breast carcinoma mimicking granular cell tumor. J Cutan Pathol 1989; 16: 218–21.
Rogow L, Rotman M, Roussis K. Renal metastases simulating Kaposi sarcoma. Arch Dermatol 1975; 111: 717–9.
DiSibio G, French SW. Metastatic patterns of cancers: results from a large autopsy study. Arch Pathol Lab Med 2008; 6: 931–9.
Mahalingam M, Nguyen LP, Richards JE, Muzikansky A, Hoang MP. The diagnostic utility of immunohistochemistry in distinguishing primary skin adnexal carcinomas from metastatic adenocarcinoma to skin: an immunohistochemical reappraisal using cytokeratin 15, nestin, p63, D2-40, and calretinin. Mod Pathol 2010; 23: 713–9.
Lee JJ, Mochel MC, Piris A, Boussahmain C, Mahalingam M, Hoang MP. p40 exhibits better specificity than p63 in distinguishing primary skin adnexal carcinomas from cutaneous metastases. Hum Pathol 2014; 45: 1078–83.
Sariya D, Ruth K, Adams-McDonnell R, et al. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. Arch Dermatol 2007; 143: 613–20.
Sariya D, Ruth K, Adams-McDonnell R, et al. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. Arch Dermatol 2007; 143: 613–20.
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Guanziroli, E., Coggi, A., Venegoni, L. et al. Cutaneous metastases of internal malignancies: an experience from a single institution. Eur J Dermatol 27, 609–614 (2017). https://doi.org/10.1684/ejd.2017.3142
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DOI: https://doi.org/10.1684/ejd.2017.3142