Cutaneous metastases of internal malignancies: an experience from a single institution
- 49 Downloads
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.
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.
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.
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.
Key wordscutaneous metastasis histopathology immunohistochemistry internal malignancy
Unable to display preview. Download preview PDF.
- 12.Saeed S, Keehn CA, Morgan MB. Cutaneous metastases: a clinical, pathological and immunohistochemical appraisal. J Cutan Pathol 1994; 31: 419–30.Google Scholar
- 15.Nashan D, Meiss F, Braun-Falco M, et al. Cutaneous metastases from internal malignancies. Dermatol Therapy 2010; 23: 567–80.Google Scholar
- 20.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.Google Scholar
- 28.Reuter MJ, Nomland R. Inflammatory cutaneous metastatic carcinoma. Wis Med J 1941; 40: 196–201.Google Scholar
- 34.Itin P, Tomaschett S. Cutaneous metastases from malignancies which do not originate from the skin. An epidemiological study. Internist (Berl) 2009; 50: 179–86.Google Scholar
- 38.Gates O. Cutaneous metastases of malignant disease. Am J Cancer 1937; 30: 718–30.Google Scholar
- 43.Ingram JT. Carcinoma erysipelatoides and carcinoma telangiectaticum. AMA Arch Dermatol 1958; 77: 227–31.Google Scholar
- 44.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.Google Scholar
- 45.Delacretas J, Chapuis H. Metastases cutanees alopeciantes. Dermatologica 1958; 116: 372–3.Google Scholar
- 56.DiSibio G, French SW. Metastatic patterns of cancers: results from a large autopsy study. Arch Pathol Lab Med 2008; 6: 931–9.Google Scholar
- 57.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.PubMedGoogle Scholar