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Vernemmen AIP, Li X, Roemen GMJM, Speel EJM, Kubat B, Hausen AZ, Winnepenninckx VJL, Samarska IV. Cutaneous metastases of internal malignancies: a single-institution experience. Histopathology 2022; 81:329-341. [PMID: 35758186 PMCID: PMC9544513 DOI: 10.1111/his.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Aims Cutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer. Materials and methods A retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases. Results We identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender. Conclusion Breast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.
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Affiliation(s)
- Astrid I P Vernemmen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Xiaofei Li
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Guido M J M Roemen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bela Kubat
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Axel Zur Hausen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Véronique J L Winnepenninckx
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Iryna V Samarska
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Kaminska-Winciorek G, Pilśniak A, Piskorski W, Wydmański J. Skin metastases in the clinical and dermoscopic aspects. Semin Oncol 2022; 49:160-169. [DOI: 10.1053/j.seminoncol.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
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Bohli M, Tebra S, Bouaouina N. Nasopharyngeal carcinoma with cutaneous metastases. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:409-411. [PMID: 31000368 DOI: 10.1016/j.anorl.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cutaneous metastases from nasopharyngeal carcinoma are extremely rare and associated with a poor prognosis. CASE REPORTS We retrospectively reviewed 820 patients with nasopharyngeal carcinoma treated over a 20-year period in the radiotherapy department of Farhat Hached hospital in Sousse and Ibn Khaldoun Medical centre, Hammam Sousse. Two of these patients presented cutaneous metastases. The skin lesions appeared during radiotherapy and 3 months after treatment of the primary tumour. Cutaneous metastases present as multiple painless nodules and erythematous plaques. Cutaneous metastases were associated with other metastatic sites (liver, bone). One patient received chemotherapy. Both patients died in a context of rapidly progressive disease. DISCUSSION Nasopharyngeal carcinoma with cutaneous metastases is a rapidly fatal disease. In the light of these two cases and a review of the literature, patients with this disease are aged between 30 and 63 years with a marked male predominance. Cutaneous metastases are correlated with a more advanced primary tumour. The main sites are the trunk and scalp. There is no standard treatment modality for this disease and survival does not exceed 9 months.
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Affiliation(s)
- M Bohli
- Department of radiotherapy, Farhat Hached hospital, Sousse, Tunisia.
| | - S Tebra
- Department of radiotherapy, Farhat Hached hospital, Sousse, Tunisia
| | - N Bouaouina
- Department of radiotherapy, Farhat Hached hospital, Sousse, Tunisia
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4
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Caccavale S, Brancaccio G, Agozzino M, Vitiello P, Alfano R, Argenziano G. Obligate and facultative paraneoplastic dermatoses: an overview. Dermatol Pract Concept 2018; 8:191-197. [PMID: 30116663 PMCID: PMC6092071 DOI: 10.5826/dpc.0803a09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Dermatological paraneoplastic syndromes are a group of cutaneous diseases associated with malignancy, but not directly related to the primary tumor itself or to its metastases. It is of utmost importance for the dermatologist to recognize the major cutaneous paraneoplastic syndromes to diagnose the underlying tumors that trigger them as early as possible. In this overview, skin conditions that are highly correlated with malignancy, whose recognition implies a mandatory investigation of internal cancer, are described.
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Affiliation(s)
- Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Marina Agozzino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Vitiello
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, Italy
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5
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6
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[Cutaneous metastasis and lung cancer]. Semergen 2016; 43:e9-e10. [PMID: 27342627 DOI: 10.1016/j.semerg.2016.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/13/2016] [Accepted: 04/26/2016] [Indexed: 11/23/2022]
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7
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Abstract
Five cases of exfoliative dermatitis in cats were presented from 1996 to 2002 in which a feline thymoma was found by postmortem or postsurgical examination. Besides abundant exfoliation of keratin squames and layers, the histologic picture of the skin revealed a similar pattern of interface dermatitis with predominantly CD3+ lymphocytes and fewer mast cells and plasma cells. In the epidermal basal layer a hydropic degeneration of keratinocytes was present. In all cases an infundibular lymphocytic mural folliculitis and absence of or drastic decrease in the number of sebaceous glands occurred. In addition to the so far described cell-poor type, we also found examples of a cell-rich skin lesion. Together with the clinical observation of generalized exfoliative dermatitis, the histologic pattern of this dermatitis was suggestive of an underlying thymoma. The pathogenesis of this skin disease in association with thymic neoplasia remains obscure, and our results contradict the hypothesis of production of autoantibodies that cross-react with epithelial antigens. The morphology of the thymomas and CD3 expression of the thymocytes varied and did not seem to have an impact on the dermal lesions.
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Affiliation(s)
- S Rottenberg
- Interdisciplinary Dermatology Unit, Institute of Animal Pathology, Vet-Suisse Faculty Bern, Länggassstrasse 122, CH-3001 Bern, Switzerland
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8
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Díaz-Martínez M, Almodóvar-Real A, Ruiz-Villaverde R, Ruiz-Carrascosa J. Mask-like Metastases: Skin Metastases With a Very Poor Prognosis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Ataş H, Gönül M, Koyuncu D, Alper M. Pityriasis rotunda: a case from Turkey. Int J Dermatol 2015; 55:e362-4. [PMID: 26695453 DOI: 10.1111/ijd.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/12/2015] [Accepted: 08/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Hatice Ataş
- Department of Dermatology, School of Medical Research, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Muzeyyen Gönül
- Department of Dermatology, School of Medical Research, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Dilek Koyuncu
- Department of Pathology, School of Medical Research, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Murat Alper
- Department of Pathology, School of Medical Research, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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10
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Díaz-Martínez MA, Almodóvar-Real A, Ruiz-Villaverde R, Ruiz-Carrascosa JC. Mask-like Metastases: Skin Metastases With a Very Poor Prognosis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:263-4. [PMID: 26563773 DOI: 10.1016/j.ad.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- M A Díaz-Martínez
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España.
| | - A Almodóvar-Real
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J C Ruiz-Carrascosa
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
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11
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Cohen JM, Cheng CE, DeSouza A, Nandi TR, Buzney EA, Larson A, Lee WY, Mostaghimi A. Hypersensitivity reaction as a harbinger of acute myeloid leukemia: a case report and review of the literature. Ann Dermatol 2015; 27:190-3. [PMID: 25834359 PMCID: PMC4377409 DOI: 10.5021/ad.2015.27.2.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022] Open
Abstract
Cutaneous paraneoplastic syndromes comprise a broad spectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread to the skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede the identification of a malignancy. We describe the case of a 79-year-old man with a six-month history of recalcitrant treatment- resistant dermatitis. A complete blood count test performed at the time of initial presentation was normal. The patient ultimately presented with erythroderma and was diagnosed with acute myeloid leukemia (AML). The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome. The patient decided against therapy and died seven weeks after diagnosis. Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly. Patients should be evaluated regularly for two to three years after initial diagnosis with a physical exam and review of systems to monitor for signs and symptoms of malignancy.
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Affiliation(s)
- Jeffrey M Cohen
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carol E Cheng
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aieska DeSouza
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tina R Nandi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Buzney
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allison Larson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Winston Y Lee
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Huang YY, Chen YL, Huang SH, Huang CY. Huge uterine leiomyoma combined with umbilical inclusion cyst mimicking a Sister Mary Joseph's nodule. Taiwan J Obstet Gynecol 2015; 54:81-3. [DOI: 10.1016/j.tjog.2014.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 10/24/2022] Open
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13
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Abstract
Cutaneous metastases of primary internal malignancies are rare, with an incidence of 0.7% to 10.4%. Cutaneous manifestations due to breast cancer are the most common metastases dermatologists observe, with a prevalence of 2.4% and an incidence of 23.9%. Presence of cutaneous metastases is usually a late event in disease progression, indicating grave prognosis. Recognition of cutaneous breast cancer metastases significantly alters therapeutic plans, especially when the disease was thought to be successfully cured. F-FDG PET CT imaging can detect cutaneous metastasis and sites of distant metastases and monitor response to therapy. We report 3 patients with cutaneous-predominant breast carcinoma seen by FDG PET/CT.
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14
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van Heerden T, Webb MJ, Barrett CL. Pityriasis rotunda as an incidental paraneoplastic finding in two patients with multiple myeloma. Clin Exp Dermatol 2014; 39:734-7. [DOI: 10.1111/ced.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 02/06/2023]
Affiliation(s)
- T. van Heerden
- Department of Internal Medicine; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - M. J. Webb
- Division of Clinical Haematology; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - C. L. Barrett
- Department of Internal Medicine; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
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15
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Fernández-Antón Martínez M, Parra-Blanco V, Avilés Izquierdo J, Suárez Fernández R. Cutaneous Metastases of Internal Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Yuste Chaves M, Unamuno Pérez P. Alertas cutáneas en malignidades sistémicas (parte 2). ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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Yuste Chaves M, Unamuno Pérez P. Cutaneous manifestations of systemic malignancies: part 2. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:543-53. [PMID: 23891448 DOI: 10.1016/j.adengl.2012.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 12/12/2022] Open
Abstract
The skin can be key to early diagnosis of systemic malignancies. In the second part of this review, we present various skin conditions that can, in certain contexts, reveal the presence of malignancy. The skin conditions are presented in groups based on a diverse range of morphological characteristics. Specifically, the following groups are analyzed: erosive and blistering lesions; inflammatory papules and nodules; xerosis, ichthyosis, and generalized exfoliative dermatitis; symptoms such as pruritus; abnormal hair distribution patterns; sweating disorders; benign tumors that can form part of hereditary syndromes associated with a risk of visceral cancer; and finally, oral and nail abnormalities. This review highlights the importance of the skin in the study of systemic malignancies.
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Affiliation(s)
- M Yuste Chaves
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain.
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18
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Yuste-Chaves M, Unamuno-Pérez P. Alertas cutáneas en malignidades sistémicas (parte I). ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Yuste-Chaves M, Unamuno-Pérez P. Cutaneous alerts in systemic malignancy: part I. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:285-98. [PMID: 23578547 DOI: 10.1016/j.adengl.2012.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 03/13/2012] [Indexed: 12/16/2022] Open
Abstract
The aim of this review is to familiarize dermatologists and clinicians in general with cutaneous signs and symptoms that can help lead to an early diagnosis of an underlying malignancy. Because the skin is one of the most accessible organs, it should never be overlooked in systemic disease. Examination of the skin has the advantage of revealing important information about the patient's condition without requiring the use of invasive techniques. In the literature, most discussions of cutaneous manifestations of internal malignancy refer to classic paraneoplastic syndromes, but a wide variety of skin conditions, while not strictly paraneoplastic, can, in certain contexts, indicate the presence of malignancy or an increased risk of developing cancer later in life. In this review, various skin conditions that can signal malignancy or increased cancer risk are presented in randomly ordered groups based on clinical morphology. Conditions with multiple signs and symptoms have been classified on the basis of their most characteristic feature.
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Affiliation(s)
- M Yuste-Chaves
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain.
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20
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Manohar K, Mittal BR, Bhattacharya A, Singh G. Asymptomatic Distant Subcutaneous Metastases Detected by (18)F-FDG-PET/CT in a Patient with Breast Carcinoma. World J Nucl Med 2012; 11:24-5. [PMID: 22942779 PMCID: PMC3425225 DOI: 10.4103/1450-1147.98742] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cutaneous metastases from internal malignancies are rare with a reported incidence between 0.7% and 10%. We report a case with distant skin and subcutaneous metastases in abdominal skin from breast cancer detected on (18)F-fluoro-deoxyglucose-positron emission tomography/computed tomography imaging.
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Affiliation(s)
- Kuruva Manohar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Fernández-Antón Martínez MC, Parra-Blanco V, Avilés Izquierdo JA, Suárez Fernández RM. Cutaneous metastases of internal tumors. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:841-53. [PMID: 22853962 DOI: 10.1016/j.ad.2012.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/23/2012] [Accepted: 06/02/2012] [Indexed: 01/10/2023] Open
Abstract
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.
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22
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Floristán Muruzábal U, Romero-Maté A, Ruiz-Casado AI, Ortega-Pérez G, Vlagea A, Diego-Polo VD, Borbujo JM. Generalised Pruritus and Elevated Levels of Immunoglobulin E Acting as Biomarkers of a Malignant Peritoneal Mesothelioma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n2p91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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Nashan D, Meiss F, Braun-Falco M, Reichenberger S. Cutaneous metastases from internal malignancies. Dermatol Ther 2011; 23:567-80. [PMID: 21054703 DOI: 10.1111/j.1529-8019.2010.01364.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Dorothée Nashan
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
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24
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Ivan D, Prieto VG. Histopathology of inflammatory skin disease in oncological patients. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mpdhp.2009.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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26
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Cutaneous metastases of visceral tumours: a review. J Cancer Res Clin Oncol 2008; 135:1-14. [PMID: 18560891 DOI: 10.1007/s00432-008-0432-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 05/26/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 10% of all visceral malignancies develop cutaneous metastases. As cutaneous metastases are underestimated and underdiagnosed they can be a clinical challenge. The clinical appearance and patterns of distribution of cutaneous metastases, the characterisation of clinical outcomes and available therapeutic options are compiled. PATIENTS AND METHODS Literature (over the last 6 years) MESH in terms of cutaneous metastases was comprehensively evaluated. Characteristics from 92 available cases are elaborated and adjusted with terms (time unlimited) of published epidemiological reviews to single organs. RESULTS The broad clinical spectrum with differential diagnoses is displayed. An allocation of cutaneous metastases and a particular organ is not reliable. In 22% of all cases cutaneous metastases can lead to the diagnosis of an internal malignoma. The majority of cases reveal cutaneous metastases to emerge in a tumour-free interval in about 36 months, after a successful treatment of the primary tumour, most commonly along with other organ metastases. Probable survival turned out to be less than 12 months. Consistently with this end-stage condition, treatment aligns with rules of palliation. Local treatment of choice is excision. Only a minority of investigators attempted to come up with tumour-specific treatment strategies, and almost no randomised therapy studies can be presented. CONCLUSION A reference guide of cutaneous metastases is given; the clinical spectrum is adjusted to an actual status; state of the art of the treatment is accomplished. An epidemiological, improved registration and diagnostic work-up for targeted therapies in conjunction with dermatologists are favoured.
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Abstract
PURPOSE A skin finding may be an indicator of internal malignant diseases. In this report, we investigated the skin findings of the cases who have had internal malignancy within the last 1 month. PATIENTS AND METHODS Seven hundred cases who were diagnosed as internal malignancy and who did not have any treatment for the malignancy were enrolled in our study between February 2002 and September 2003. A form was completed for all of the cases, including name, surname, and the carcinoma type. All cases were examined in detail, and the observed skin findings or dermatosis was recorded. RESULTS The most frequent skin findings among the cases were tinea pedis/onychomycosis, followed by xerosis and pruritus. The skin findings in terms of frequency were determined mostly in hematological malignancies (68.96%). CONCLUSION We would like to emphasize that the skin is an indicator of the functions of internal organs and their disorders.
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Affiliation(s)
- Arzu Kiliç
- Ankara Numune Education and Research Hospital, 2nd Dermatology Clinic, Ankara, Turkey.
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28
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Lung, bone, skeletal muscles and cutaneous metastases from adenoid cystic carcinoma of the parotid gland: a case report and review of the literature. Med Oncol 2007; 24:458-62. [DOI: 10.1007/s12032-007-0016-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 11/30/1999] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
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29
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Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy: diagnosis and management. Am J Clin Dermatol 2006; 7:71-84. [PMID: 16605288 DOI: 10.2165/00128071-200607020-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
An association between systemic malignancy and cutaneous manifestations has long been recognized. The cutaneous features that can occur are numerous and heterogeneous, and many different etiologic mechanisms are represented - from direct tumor invasion of skin or distant metastases to a wide variety of inflammatory dermatoses that may occur as paraneoplastic phenomena. In addition, there are a number of inherited syndromes that carry an increased risk of cutaneous as well as internal malignancies. While some of these inherited syndromes and paraneoplastic phenomena are exceedingly rare, all clinicians will be aware of the common cutaneous manifestations of advanced malignant disease such as generalized xerosis and pruritus. This review classifies these wide-ranging cutaneous manifestations of internal malignancy into five basic groups and provides practical advice regarding diagnosis and screening of patients who initially present with a cutaneous complaint. Also included is up-to-date information on two rapidly expanding and exciting areas of research that are likely to have far-reaching clinical implications: (i) clarification of underlying humoral mechanisms, for example, in the malignant carcinoid syndrome; and (ii) identification of an increasing number of specific genetic defects that confer a susceptibility to malignancy.Increased clinician awareness regarding the associations between these lesions and internal malignancy or inherited syndromes will facilitate screening and early diagnosis.
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Affiliation(s)
- C Elise Kleyn
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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Chung VQ, Moschella SL, Zembowicz A, Liu V. Clinical and pathologic findings of paraneoplastic dermatoses. J Am Acad Dermatol 2006; 54:745-62; quiz 763-6. [PMID: 16635655 DOI: 10.1016/j.jaad.2004.06.051] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2004] [Indexed: 12/21/2022]
Abstract
UNLABELLED Paraneoplastic dermatoses comprise a heterogeneous group of noninherited skin conditions that manifest internal malignancy. Familiarity with paraneoplastic dermatoses is important to both clinician and pathologist alike, as recognition of such a condition offers opportunity for early diagnosis and treatment of internal malignancy; monitoring for tumor recurrence; and insight into pathophysiology which may yield possible clues to treatment. Herein are reviewed 16 of the best established paraneoplastic dermatoses that display distinctive clinical and pathologic findings. LEARNING OBJECTIVE At the conclusion of this leaning activity, participants should be able to recognize, diagnose, and describe the clinical and pathologic findings of paraneoplastic dermatoses.
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Affiliation(s)
- Vinh Q Chung
- Harvard Medical School, Boston, Massachusetts, USA
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Laetsch B, Hofbauer G, Kempf W, Burg G, Dummer R. Atypical Poorly Differentiated Cutaneous T-Cell Lymphoma with an Angiocentric Growth Pattern Presenting Histologically as Vasculitis. Dermatology 2005; 210:341-5. [PMID: 15942225 DOI: 10.1159/000084763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 09/24/2004] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 41-year-old patient with an aggressive cutaneous T-cell lymphoma (CTCL) initially presenting on histology as lymphocytic vasculitis. On repeated histological examination and by molecular biology work-up, the diagnosis of an unclassifiable CTCL could eventually be established. This atypical poorly differentiated lymphoma was of a CD4+ CD8- CD56- phenotype and followed an unfavourable course. The patient died despite chemo- and immunotherapy 7 months after the first consideration of lymphoma as diagnosis.
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Affiliation(s)
- B Laetsch
- Dermatologische Klinik, Universitätsspital Zürich, Zürich, Schweiz
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Schubert RD, Weiss T, Weiss JM, Scharffetter-Kochanek K, Weber L. [Multiple quickly changing tumors on the head and trunk of a 47-year old man]. Hautarzt 2005; 56:586-9. [PMID: 15700157 DOI: 10.1007/s00105-004-0859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R D Schubert
- Universitätsklinik für Dermatologie und Allergologie, Ulm.
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Spasser MA. Resource navigation for clinical authors. Med Ref Serv Q 2004; 23:51-62. [PMID: 15119840 DOI: 10.1300/j115v23n01_05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Web continues to grow in a largely unregulated manner. It is an established role of health sciences librarians to assist busy clinicians and other health care professionals cope with "information overload" by helping them locate useful and valuable information resources. One time-honored means of doing so is to prepare annotated bibliographies of such resources, perhaps no more so than to manage such cross-disciplinary topics as writing for publication. This article recommends resources to assist clinician writers publishing their research and other writings and suggests search strategies to update these resources as needed.
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Affiliation(s)
- Mark A Spasser
- Library & Information Services, Jewish Hospital College of Nursing & Allied Health, Washington University Medical Center, MS:90-30-625, 306 South Kingshighway Boulevard, St. Louis, MO 63110-1091, USA.
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Abstract
The NLM Gateway is a single Web interface for searching multiple NLM databases. While the majority of the available databases can be accessed directly via their own Web sites, such as PubMed, there are three databases that are unique to the NLM Gateway, including the ever-expanding OLDMEDLINE files. Thus, the Gateway is a necessary tool for librarians and researchers to be familiar with and have handy.
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Affiliation(s)
- Patricia Tomasulo
- Ehrman Medical Library, New York University Medical Center, 550 1st Avenue, New York, NY 10016, USA.
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