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

Recent trends (1991-2010) of metastatic skin cancers in Korea

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women, and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.

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.

Scalp metastasis from leiomyosarcoma of the inferior vena cava sign as the first clinical sign: a case report

The presentation of scalp metastases from leiomyosarcoma of the vena cava is an extremely infrequent event. There are no other publications that describe such finding and very few of leiomyosarcoma in vessels. About this event we have reviewed the English literature describing studies on scalp metastases and skin metastases in general: their incidence, origin, clinical appearance, meaning, and diagnosis. The case we describe would be the second one presented worldwide because, as far as we know, it has been only one more published in 2005.

Case for diagnosis. Cutaneous metastases of visceral cancer

Cutaneous metastases of visceral cancers are relatively rare, with an incidence of 0.7 to 10%. The most frequent primary sites are breast, lung and colon tumors. They generally occur after the primary cancer is diagnosed and signify a poor prognosis. They may occur as the first manifestation in 20% of cancers in general. The most common manifestations are single or multiple asymptomatic nodules, most often located on the chest, abdomen, head and neck, sometimes with unusual clinical features which present a challenge to clinical diagnosis.

Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review

Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.

Cutaneous metastases of internal tumors

Cutaneous metastases are relatively rare in clinical practice and their diagnosis requires a high index of suspicion because clinical findings can be subtle. These metastases reveal the presence of disseminated malignant disease and can lead to the diagnosis of unsuspected internal tumors or the spread or recurrence of an already diagnosed tumor. Early recognition of cutaneous metastases can facilitate prompt and accurate diagnosis resulting in early treatment; however, they are generally indicative of a poor prognosis. Some tumors have a predilection to metastasize to specific areas. Recognition of these patterns provides essential information that can guide the search for the underlying tumor.

Cutaneous relapse of an ampullary carcinoma: an unusual presentation

This is the first ever reported case about a cutaneous relapse of small bowel adenocarcinoma. The ampulla of Vater is the area of the small bowel that presents more frequently malignant transformation, nevertheless ampullary adenocarcinomas are rare but aggressive diseases. However, distant metastases are infrequent. Cutaneous metastases constitute the 5.3% of skin tumours, and are usually found in the 12% of malignancies. Their management usually includes local treatment if they are unique and systemic treatment when they are multiple. Chemotherapy schemes used in ampullary adenocarcinoma are those used in cholangiocarcinomas, pancreas and tumours of the gallbladder; nevertheless, given the intestinal origin of these tumours combinations of capecitabine and oxaliplatin are commonly used.

Clinicopathological correlation of cutaneous metastatic breast carcinoma using lymphatic and vascular markers: lymphatics are mainly involved in cutaneous metastasis

Precise clinicopathological correlations of the clinical features of metastatic breast carcinoma with lymphatic-specific markers are rare. We classified 28 patients with metastatic breast carcinoma according to their clinical features. Immunohistochemical staining was performed using D2-40, CD31 and CD34. Of the 28 patients, 8 (28.6%) had inflammatory metastatic carcinoma, 6 (21.4%) had the telangiectatic type, 5 had the nodular type, 3 had the en cuirasse type, 3 had alopecia neoplastica, and 3 had a combination of features. D2-40 staining revealed dilated lymphatic channels (lymphangiectasia) in the upper dermis of all patients; in addition, 13 patients (46.4%) had intralymphatic tumour-cell emboli, which were common in those with the inflammatory and telangiectatic types. Intratumoral lymphatic invasion in the main tumour nodule was seen in 12 patients (42.9%). Our results suggest that cutaneous metastatic breast carcinomas have various clinical presentations, and that lymphatic vessels play an important role in all types of cutaneous metastasis.

Multifocal cutaneous metastases from squamous cell carcinoma of hard palate

Distant metastases from oral squamous cell carcinoma are unusual, but generally occur in lungs, bone, and liver. Cutaneous metastasis is extremely rare, and it often reflects an advanced stage with sinister prognosis. The authors report an 81-year-old male patient with multifocal cutaneous metastases from a recurrent squamous cell carcinoma of the hard palate 5 months after primary treatment.

Cutaneous metastasis from cholangiocarcinoma as the first clinical sign: a report of two cases

Cutaneous metastases from internal malignancies are uncommon. Furthermore, cutaneous metastases from cholangiocarcinoma are extremely rare. Here we report a case of two patients with distant cutaneous metastases of cholangiocarcinoma: 1) a 66-year-old man who presented with a solitary, erythematous nodule on the scalp and 2) a 44-year-old man who presented with multiple, erythematous nodules on the scalp, the chest wall, and the back. In both cases, the erythematous nodules were the first clinical signs of cholangiocarcinoma. Histopathological analyses of skin biopsy specimens of the two patients revealed adenocarcinomas with features similar to the original cholangiocarcinoma. Two cases of cholangiocarcinoma in which metastatic skin nodules appeared as the first sign of the disease are reported here, with a review of the relevant literature.

Cutaneous metastases from internal malignancies

Cutaneous metastases of internal malignancies still seem to occur infrequently, although medical publications report an incidence rate of up to 10.4%. Common sense, however, fosters suspicion that we might underdiagnose the problem distracted by harder striking facets of an advanced disease. With contemporary knowledge, morphology and behavior of cutaneous metastases resemble each other regardless of the site of origin. This article itemizes clinical presentations according to organ systems, specific features, and differential diagnoses. In general, the survival turned out to be less than 12 months. But incremental awareness of cutaneous metastases proclaims this paradigm insufficient. Although excision is the local treatment of choice, investigations attempt to propose tumor-specific chemotherapeutic/immunological approaches. This paper endeavors to critically review the state of the art concerning the clinic, prognosis, and therapeutic concepts.

Hepatobiliary malignancies with cutaneous metastases: an analysis of 8 cases

AIM: To analyze the clinical characteristics and therapeutic outcomes of 8 cases of hepatobiliary malignancies with cutaneous metastases.

METHODS: From June 2006 to June 2009, eight patients with cutaneous metastases from hepatobiliary malignancies were treated at our hospital. By retrospectively reviewing the clinical data for these patients, the clinical characteristics, treatment and prognosis of this disease were summarized.

RESULTS: One patient with hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by bile duct tumor thrombi developed cutaneous metastasis at the port site 20 mo after percutaneous transhepatic biliary drainage (PTBD). The patient had survived 16 mo after resection of the port-site tumor and showed no recurrence. One HCC patient developed tumor at the incision site 9 mo after abdominal exploration. After the skin and liver tumors were excised, the patients survived 8 mo. One patient with combined HCC and cholangiocellular carcinoma developed multiple cutaneous metastases of cholangiocellular carcinoma and survived 8 mo. Two patients with cholangiocarcinoma and solitary nodular cutaneous metastasis received skin tumor excision and survived 8 and 10 mo, respectively. Of three patients with cholangiocarcinoma and multiple cutaneous metastases, one received chemotherapy and survived 6 mo, and the other 2 refused any treatment and survived 3 and 4 mo, respectively.

CONCLUSION: Puncture and operation procedures should be improved to avoid seeding metastasis. In patients with hepatobiliary malignancies, solitary nodular cutaneous metastasis has a better prognosis, while multiple cutaneous metastases have a worse prognosis.

Rates of cutaneous metastases from different internal malignancies: experience from a Taiwanese medical center

BACKGROUND

Previous reports regarding the rates at which various internal tumors metastasize to the skin have been limited and have only included the Caucasian population. Moreover, the mechanisms that predispose certain internal malignancies to metastasize to the skin have rarely been discussed in the scientific literature.

OBJECTIVES

We determined the frequencies with which various internal malignancies metastasize to the skin in patients from a Taiwanese medical center. We also evaluated whether expressions of chemokine receptors CCR10 and CXCR4 by tumor cells correlate with cutaneous metastatic ability.

METHODS

Clinical records from Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, during 20 years (1986-2006) were reviewed and cases of biopsy-proven primary internal malignancies and cutaneous metastases were identified. Immunohistochemical staining with antibodies to CCR10 and CXCR4 was performed on a selected number of internal malignancies with and without skin metastases.

RESULTS

From 12,146 patients with internal malignancies, we found 124 cases (1.02%) with cutaneous metastases. The highest rates of skin metastases were found to occur from carcinoma of the breast, followed by the lung, oral mucosa, colon and rectum, stomach, and esophagus. However, the rate of cutaneous metastasis from breast cancer was much lower compared with previous studies involving Caucasians. In general, adenocarcinomas gave rise to cutaneous metastases at a higher frequency compared with other histologic subtypes. In addition, the expressions of CCR10 and CXCR4 by tumor cells did not correlate well with the presence or absence of skin metastases.

LIMITATION

This study is retrospective in nature.

CONCLUSIONS

Different internal malignancies metastasize to the skin with different frequencies, and the rates at which different malignancies metastasize to cutaneous sites differ between the Taiwanese and Caucasian populations. The mechanisms responsible for the cutaneous metastatic ability of certain malignancies likely involve factors other than chemokine receptors CCR10 and CXCR4, because their expressions by tumor cells are neither necessary nor sufficient for the formation of skin metastases.