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Eisendle K, Kofler L. Shedding light on cutaneous metastases. J Eur Acad Dermatol Venereol 2024; 38:1240-1241. [PMID: 38932661 DOI: 10.1111/jdv.20067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Klaus Eisendle
- Department of Dermatology Venereology and Allergology, Central Teaching Hospital Bolzano-Bozen, Bolzano-Bozen, Italy
- Department of Dermatology and Venereology, Rīga Stradiņš University, Rīga, Latvia
- Claudiana College of Health Professions, Bolzano-Bozen, Italy
| | - Lukas Kofler
- Center for Skin Diseases Hautzentrum am Holzmarkt, Biberach a.d.R, Germany
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
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2
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Murphy CM, Wang K, Wachuku C, Prasad A, Dhawan I, Morgan EE, Brown KK, Wang L. Metastatic gastric adenocarcinoma to the cutaneous neck and chest wall. SAGE Open Med Case Rep 2024; 12:2050313X241231515. [PMID: 38404499 PMCID: PMC10894527 DOI: 10.1177/2050313x241231515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024] Open
Abstract
This case describes an atypical cutaneous presentation of metastatic gastric carcinoma in a patient initially presenting with dysphagia and a sclerotic red plaque overlying the anterior neck and chest. Skin biopsy revealed metastatic adenocarcinoma from the upper gastrointestinal tract. Esophagogastroduodenoscopy revealed stage IV metastatic gastric adenocarcinoma. Treatment with chemotherapy was initiated.
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Affiliation(s)
- Christina M Murphy
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Wang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Aman Prasad
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ishita Dhawan
- Division of Gastroenterology, Cooper University Hospital, Camden, NJ, USA
| | - Eric E Morgan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine K Brown
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Leo Wang
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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Ibrahim-Shaikh S, Shaikh N, Daboul N, Alshaikhnassir E, Hafez M, Freiser ME. Metastatic Esophageal Adenocarcinoma Presenting as Neck Dermal Metastasis. Case Rep Dermatol Med 2024; 2024:7951391. [PMID: 38264294 PMCID: PMC10805548 DOI: 10.1155/2024/7951391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/18/2023] [Accepted: 11/15/2023] [Indexed: 01/25/2024] Open
Abstract
Dermal metastasis is a rare manifestation of visceral disease, and esophageal adenocarcinomas represent around only 1% of primaries that present with cutaneous metastasis. In this case, we discuss a patient who presented with a painless submental mass and extensive right neck cutaneous induration and erythema. Core needle biopsy demonstrated poorly differentiated adenocarcinoma. Blood testing also demonstrated elevated carbohydrate antigen 19-9, carcinoembryonic antigen, and alkaline phosphatase. PET/CT followed by esophagoscopy led to the diagnosis of esophageal signet-cell adenocarcinoma primary with isolated dermal metastasis. The patient was started on palliative radiotherapy and passed away two months later from a suspected thoracic fistula and hydropneumothorax.
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Affiliation(s)
| | - Noah Shaikh
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Nour Daboul
- Department of Hematology/Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Esra Alshaikhnassir
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
| | - Maria Hafez
- Department of Hematology/Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Monika E. Freiser
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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4
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Baczynski A, Medhus E, Skopis P, Ahmed A. Cutaneous metastasis of urothelial carcinoma. IJU Case Rep 2024; 7:5-7. [PMID: 38173450 PMCID: PMC10758891 DOI: 10.1002/iju5.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/28/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Cutaneous metastasis of urothelial carcinoma is a rare occurrence, accounting for a small percentage of skin metastases in cancer patients. This case presentation highlights the importance of considering cutaneous metastasis in patients with a history of urologic malignancy presenting with new dermal nodules. Case presentation A 79-year-old male with a history of papillary urothelial carcinoma of the bladder and metastasis to the rectum presented with a painful and pruritic rash in the right inguinal region. Physical examination revealed firm papulonodules forming confluent, hyperpigmented to violaceous plaques. A punch biopsy confirmed the diagnosis of cutaneous metastasis of urothelial carcinoma based on histopathological and immunohistochemical findings. Conclusion While cutaneous metastasis is uncommon in urothelial carcinoma, early recognition and diagnosis are crucial in guiding patient management and setting realistic expectations regarding prognosis. Timely identification of cutaneous lesions can help facilitate appropriate treatment decisions and discussions of goals of care.
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Affiliation(s)
| | - Emily Medhus
- Department of DermatologyRush University Medical CenterChicagoIllinoisUSA
| | - Penelope Skopis
- Department of DermatologyRush University Medical CenterChicagoIllinoisUSA
| | - Aadil Ahmed
- Department of DermatologyRush University Medical CenterChicagoIllinoisUSA
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5
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Shin DM, Jung YJ, Kim H, Oh SJ, Shim J, Lee JH, Lee DY, Park J. Clinical characteristics and survival analysis of cutaneous metastases in a single tertiary centre in Korea. J Eur Acad Dermatol Venereol 2023; 37:2311-2318. [PMID: 37467154 DOI: 10.1111/jdv.19361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Cutaneous metastasis (CM) refers to the spread of malignancy to the skin. CM is perceived as an advanced stage. It might be the first sign of a primary cancer or an indicator of recurrence. OBJECTIVES To identify primary cancers associated with CMs and perform a survival analysis according to advanced stage of cutaneous metastasis at a single tertiary centre in Korea. METHODS A total of 219 patients from Samsung Medical Center from January 2009 to April 2020 were retrospectively analysed to identify cases with biopsy-proven CMs. According to advanced stage of metastasis, patients were divided into three stages, CM only (CMO), CM with lymph node metastasis (CM/LM) and CM with distant metastasis (CM/DM), to analyse clinical characteristics and survival rate. RESULTS The most common CM from primary cancer was breast cancer, followed by lung cancer, stomach cancer, colorectal cancer and others. When all primary cancers were included, the median survival period was 4.82 years for the CMO stage, 2.15 years for the CM/LM stage and 0.80 years for the CM/DM stage, with a tendency to deteriorate with advancing stage. At 1- and 3-year after occurrence of CM, the CM/DM stage showed a significantly poorer survival rate than the other two stages. CONCLUSIONS This study showed a median survival period of 22 months for CM patients overall. Breast cancer has greater accessibility to the skin than other cancers. Therefore, breast cancer can metastasize to the skin without involving lymph nodes or other sites.
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Affiliation(s)
- Dong Min Shin
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Joo Jung
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heeyeon Kim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joonho Shim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Di Raimondo C, Lozzi F, Di Domenico PP, Campione E, Bianchi L. The Diagnosis and Management of Cutaneous Metastases from Melanoma. Int J Mol Sci 2023; 24:14535. [PMID: 37833981 PMCID: PMC10572973 DOI: 10.3390/ijms241914535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Melanoma is one of the deadliest skin tumors, accounting for almost 90% of skin cancer mortality. Although immune therapy and targeted therapy have dramatically changed the prognosis of metastatic melanoma, many patients experience disease progression despite the currently available new treatments. Skin metastases from melanoma represent a relatively common event as first sign of advanced disease or a sign of recurrence. Skin metastases are usually asymptomatic, although in advanced stages, they can present with ulceration, bleeding, and superinfection; furthermore, they can cause symptoms related to compression on nearby tissues. Treatments vary from simple surgery resections to topical or intralesional local injections, or a combination of these techniques with the most recent systemic immune or target therapies. New research and studies should focus on the pathogenesis and molecular mechanisms of the cutaneous metastases of melanoma in order to shed light on the mechanisms underlying the different behavior and prognoses of different patients.
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Affiliation(s)
- Cosimo Di Raimondo
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy; (F.L.); (P.P.D.D.); (E.C.); (L.B.)
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Souza BDCE, Miyashiro D, Pincelli MS, Sanches JA. Cutaneous metastases from solid neoplasms - Literature review. An Bras Dermatol 2023; 98:571-579. [PMID: 37142464 PMCID: PMC10404505 DOI: 10.1016/j.abd.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 05/06/2023] Open
Abstract
Cutaneous metastases from solid tumors are uncommon events in clinical practice. Most of the time, the patient already has the diagnosis of a malignant neoplasm when the cutaneous metastasis is detected. However, in up to one-third of cases, cutaneous metastasis is identified before the primary tumor. Therefore, its identification may be essential for starting treatment, although it is usually indicative of poor prognosis. The diagnosis will depend on clinical, histopathological, and immunohistochemical analysis. Sometimes the identification of the primary site is difficult; however, a thorough analysis using imaging tests and constant surveillance is important.
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Affiliation(s)
- Bruno de Castro E Souza
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Denis Miyashiro
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcella Soares Pincelli
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Antonio Sanches
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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8
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Vissing M, Pervan M, Pløen J, Schnefeldt M, Rafaelsen SR, Jensen LH, Rody A, Gehl J. Calcium electroporation in cutaneous metastases - A non-randomised phase II multicentre clinical trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106925. [PMID: 37268521 DOI: 10.1016/j.ejso.2023.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cutaneous metastases can cause distressing symptoms and be challenging to treat. Local therapies are essential in management. Calcium electroporation uses calcium and electrical pulses to selectively kill cancer cells. This multicentre study aimed to define response in cutaneous metastases across different cancer types. METHODS Patients with tumours ≤3 cm of any histology were included (stable or progressing on current therapy ≥2 months), at three centres. Tumours were treated with 220 mM calcium chloride injection and manual application of eight 0.1 ms pulses with 1 kV/cm and 1Hz with a handheld electrode, in local or general anaesthesia. Clinical response was evaluated after 1, 2, 3, 4, 5, 6, and 12 months. Primary endpoint was response at two months. The overall response rate (ORR) was partial- and complete responses of treated tumours. MR-imaging and qualitative interviews were performed in respective subsets. RESULTS Nineteen patients with disseminated cancer (breast n = 4, lung n = 5, pancreatic n = 1, colorectal n = 2, gastric n = 1, and endometrial cancer n = 1) were enrolled, and 58 metastases were treated (50 once, 8 retreated). The ORR was 36% (95% CI 22-53) after two months. Best ORR was 51% (CR 42%; PR 9%). Previous irradiation improved outcomes (p = 0.0004). Adverse events were minimal. Median pain score was reduced after two months (p = 0.017). Treatment may relieve symptoms according to qualitative interviews. MRI showed restriction in treated tissue. CONCLUSION The majority of tumours were treated only once with calcium electroporation, achieving an ORR of 36% after two months and best ORR of 51%. Efficacy, symptom-relief and safety support calcium electroporation as a palliative treatment option for cutaneous metastases.
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Affiliation(s)
- Mille Vissing
- Center for Experimental Drug and Gene Electrotransfer (C∗EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Ringstedgade 61, 4700, Næstved, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Mascha Pervan
- Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Germany Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - John Pløen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Mazen Schnefeldt
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Achim Rody
- Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Germany Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C∗EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Ringstedgade 61, 4700, Næstved, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
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Di Prata C, Mascherini M, Ross AM, Silvestri B, Kis E, Odili J, Fabrizio T, Jones RP, Kunte C, Orlando A, Clover J, Kumar S, Russano F, Matteucci P, Muir T, Terlizzi FD, Gehl J, Grischke EM. Efficacy of Electrochemotherapy in Breast Cancer Patients of Different Receptor Status: The INSPECT Experience. Cancers (Basel) 2023; 15:3116. [PMID: 37370726 DOI: 10.3390/cancers15123116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Electrochemotherapy has been proven to be an efficient treatment for cutaneous metastases of various cancers. Data on breast cancer (BC) patients with cutaneous metastases were retrieved from the INSPECT database. Patients were divided by their receptor status: HER2+, HR+ (ER/PgR+), and TN (triple negative). Groups were similar for histological subtype and location of the nodules. Most patients were previously treated with surgery/systemic therapy/radiotherapy. We found no differences in the three groups in terms of response ratio (OR per patient 86% HER2+, 80% HR+, 76% TN, p = 0.8664). The only factor positively affecting the complete response rate in all groups was small tumor size (<3 cm, p = 0.0105, p = 0.0001, p = 0.0266, respectively). Local progression-free survival was positively impacted by the achievement of complete response in HER2+ (p = 0.0297) and HR+ (p = 0.0094), while overall survival was affected by time to local progression in all groups (p = 0.0065 in HER2+, p < 0.0001 in HR+, p = 0.0363 in TN). ECT treatment is equally effective among groups, despite different receptor status. Response and local tumor control seem to be better in multiple small lesions than in big armor-like lesions, suggesting that treating smaller, even multiple, lesions at the time of occurrence is more effective than treating bigger long-lasting armor-like cutaneous lesions.
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Affiliation(s)
- Claudia Di Prata
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Matteo Mascherini
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima-Mirano, 30035 Venice, Italy
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, H-6720 Szeged, Hungary
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London SW17 0QT, UK
| | - Tommaso Fabrizio
- Unit of Plastic Surgery, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy
| | - Rowan Pritchard Jones
- Department of Plastic Surgery, Edge Hill University, Ormskirk L39 4QP, UK
- Department of Plastic Surgery, University of Liverpool, Liverpool L7 8TX, UK
| | - Christian Kunte
- Abteilung für Dermatochirurgie und Dermatologie, Artemed Fachklinik München, 80336 Munich, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - James Clover
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
- Cancer Reseach@UCC, University College Cork, T12 YN60 Cork, Ireland
| | - Siva Kumar
- Department of Plastic Surgery, Queen Victoria Hospital National Health Service (NHS) Foundation Trust, East Grinstead RH19 3DZ, UK
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Paolo Matteucci
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - Tobian Muir
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | | | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, 72076 Tübingen, Germany
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Wang B, Chen J, Wang Y, Dong LL, Shen GF. Edema of limbs as the primary symptom of gastric signet-ring cell carcinoma: A case report and literature review. World J Gastrointest Oncol 2022; 14:2404-2414. [PMID: 36568945 PMCID: PMC9782619 DOI: 10.4251/wjgo.v14.i12.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metastatic skin cancers are relatively rare dermatological malignancies. They usually present as nodules, erythematous lesions, scar-like lesions or other lesion types. Signet-ring cell carcinoma (SRCC) is an uncommon histological type of gastric cancer that usually behaves aggressively and has a poor prognosis. Skin metastasis may be the first sign of clinically silent visceral cancer or recurrence of an internal malignancy.
CASE SUMMARY Herein we report on the case of a 55-year-old man with edema of a lower extremity as the primary symptom which progressed from local to generalized pitting edema in the year following skin involvement. Pathological evidence from gastroscopic specimens and subcutaneous tissue biopsy showed typical signet-ring cells and gland-like structures. Consistently, immunohistochemical analysis revealed positive pan-cytokeratin expression in tumor cells. A diagnosis of gastric SRCC with skin metastasis was established. Moreover, lymphoscintigraphy showed an obvious accumulation of radiotracer on the anterior and posterior sides of the right leg which indicated lymphedema. We reviewed the relevant literature on subcutaneous metastases of gastric SRCC.
CONCLUSION This rare case emphasizes the importance of physical examination as it may help elucidate the etiology of edema.
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Affiliation(s)
- Bei Wang
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jing Chen
- Division of Cardiology, Department of Internal Medicine and Gene Therapy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ying Wang
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ling-Li Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Gui-Fen Shen
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Dumlao JKG, Cubillan ELA, Villena JPDS. Clinical and Histopathologic Profile of Patients with Cutaneous Metastasis in a Tertiary Hospital in the Philippines. Dermatopathology (Basel) 2022; 9:392-407. [PMID: 36547220 PMCID: PMC9777325 DOI: 10.3390/dermatopathology9040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cutaneous metastases represent 2% of skin tumors, with an overall incidence of 5.3%. Although rare, clinical presentations of cutaneous metastasis vary and can be mistaken for benign and malignant skin conditions. METHODOLOGY This was a descriptive, retrospective review of all patients diagnosed with cutaneous metastasis seen at the Department of Dermatology from January 2013 to December 2019. Clinical and histopathologic data from the patients were collated from medical records, and slides were retrieved for review. RESULTS A total of 115 patients were included and 122 slides reviewed. There were more female than males, the mean age was 52.3 ± 14.0 years of age. The most common primary cancer was the breast, and accordingly, the most common location was anterior chest. Among the 122 slides reviewed from 104 patients, the most common histologic type was adenocarcinoma (72.1%), and showed the infiltrative pattern (26.2%). Other histologic types seen were melanoma (13.1%), leukemic infiltrates (11.5%), squamous origin (2.5%), and epithelioid sarcoma (0.8%). Lymphovascular invasion and dermal sclerosis were observed. Immunohistochemical stains were performed in only 13.9% of the cases. There was a high concurrence of the clinical with the histopathologic diagnosis (95.6%). CONCLUSION Although rare, patients with cutaneous metastasis may present in dermatology clinics. Knowledge of clinical features and low threshold for doing biopsies may prove useful for these patients. Similarly, dermatopathologists should be able to recognize histologic features of cutaneous metastasis morphologically. Histologic features may be subtle and may be reminiscent of benign inflammatory conditions, hence judicious use of immunohistochemical staining is recommended.
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12
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Sharma H, Franklin M, Braunberger R, Hashemi-Sadraei N. Cutaneous metastasis from prostate cancer: A case report with literature review. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Niebel D, Kranert P, Berneburg M, Drexler K, Eichborn MI, Braess J, Allgäuer M, Karrer S. Indurated erythema of abdominal skin: An unusual presentation of metastatic endometrial carcinoma—Case report with literature review. SKIN HEALTH AND DISEASE 2022; 3:e136. [PMID: 37013123 PMCID: PMC10066756 DOI: 10.1002/ski2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/07/2022]
Abstract
Carcinoma erysipelatoides (CE) is a rare clinical manifestation of cutaneous metastasis, which mimics inflammatory conditions such as erysipelas. Depending on the site of the originating tumour, unusual manifestations involving different sites of the body may occur. We herein report a case of a 60-year-old female patient with metastatic endometrial carcinoma presenting as CE of the abdominal skin and the inguinal folds. Even though the diagnosis of advanced malignancy had been established before and she was currently receiving chemotherapy (carboplatin and paclitaxel), the clinical appearance closely resembled fungal (candidal intertrigo) and consecutively bacterial (erysipelas) infection, which resulted in treatment with antimycotics and antibiotics at first. Dermatohistopathological examination of skin biopsies revealed a diffuse and nodular infiltrate of pleomorphic atypical tumour cells with strong expression of cytokeratin 7 and PAX8, also detectable within lymphatic vessels. Therapy comprised antiseptic ointments to prevent superinfection, palliative electron beam radiation and supportive care. Since there were no targetable KRAS-, NRAS- and BRAF-gene mutations, systemic therapy was switched to checkpoint inhibition (pembrolizumab) in combination with lenvatinib. The overall prognosis of cutaneous metastasis of endometrial carcinoma is dismal with most patients succumbing to disease within few months. Similarly, our patient died after 3 months due to sepsis in the course of malignant pleural effusion. We aim to highlight the possibility of unusual sites of CE and the risk of respective clinical misdiagnoses.
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Affiliation(s)
- Dennis Niebel
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - Paula Kranert
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - Konstantin Drexler
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | | | - Jan Braess
- Clinic for Oncology and Hematology Krankenhaus der Barmherzigen Brüder Regensburg Germany
| | - Michael Allgäuer
- Clinic for Radiation Therapy Krankenhaus der Barmherzigen Brüder Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology University Hospital Regensburg Regensburg Germany
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Alexis F, Leggett LR, Agarwal N, Bakhtin Z, Farabi B. Carcinoma Erysipeloides With Clinical and Dermatoscopic Features: An Overlooked Clinical Manifestation of Breast Cancer. Cureus 2022; 14:e23445. [PMID: 35494933 PMCID: PMC9038511 DOI: 10.7759/cureus.23445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
Carcinoma erysipeloides (CE) is an atypical finding among women with breast cancer. CE clinically presents as an erythematous patch or plaque resembling superficial skin infections such as cellulitis or erysipelas. CE can also be the first indication of an underlying breast cancer. Therefore, it is imperative for clinicians to recognize this rare entity for early diagnosis and improving prognosis and outcomes in breast cancer patients. Here, we present a 68-year-old female patient with a history of breast cancer, who developed recurrence of cancer with typical clinical features of CE. Hence, we aim to increase awareness of this rare entity. We also report the dermatoscopic features of CE, which to the authors’ knowledge have not been previously documented in literature.
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Wang N, Li L, Xiong Y, Chi J, Liu X, Zhong C, Wang F, Gu Y. Case Report: Significant Efficacy of Pyrotinib in the Treatment of Extensive Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Cutaneous Metastases: A Report of Five Cases. Front Oncol 2022; 11:729212. [PMID: 34976791 PMCID: PMC8716402 DOI: 10.3389/fonc.2021.729212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/23/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common tumor to develop cutaneous metastases. Most BCs with cutaneous metastasis are human epidermal growth factor receptor 2 (HER2)-positive subtypes. Although the molecular mechanisms of breast cancer metastasis to different sites and the corresponding treatment methods are areas of in-depth research, there are few studies on cutaneous metastasis. CASE PRESENTATION Five HER2-positive BC patients with extensive cutaneous metastases were treated with a regimen containing pyrotinib, a novel small-molecule tyrosine kinase inhibitor that irreversibly blocks epidermal growth factor receptor (EGFR), HER2, and human epidermal growth factor receptor 4 (HER4), then their cutaneous metastases quickly resolved at an astonishing speed and their condition was well controlled during the follow-up period. CONCLUSIONS This case series reports the significant therapeutic effect of pyrotinib on cutaneous metastases of HER2-positive BC for the first time. Based on this, we recommend that pyrotinib can be used as a supplement to trastuzumab for HER2-positive BC patients with cutaneous metastases. In addition, we should consider that the pan-inhibitory effect of pyrotinib on EGFR, HER2, and HER4 may provide a dual therapeutic effect against HER2 and mucin 1.
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Affiliation(s)
- Nan Wang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Li
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Youyi Xiong
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiangrui Chi
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Liu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chaochao Zhong
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanting Gu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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16
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Metastatic Adenocarcinoma on the Scalp from the Rectum. J Gastrointest Surg 2021; 25:1625-1627. [PMID: 33169324 DOI: 10.1007/s11605-020-04853-7] [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: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 01/31/2023]
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17
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Calado R, Relvas M, Morgado F, Cardoso JC, Tellechea O. Specific cutaneous infiltrates in patients with haematological neoplasms: a retrospective study with 49 patients. Australas J Dermatol 2021; 62:e228-e235. [PMID: 33403659 DOI: 10.1111/ajd.13533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Haematological neoplasms account for around 9% of all cancers, and they are recognised as an important cause of skin infiltration. However, studies analysing cutaneous metastasis of haematological neoplasms are scarce. We describe the clinical spectrum and outcomes of specific cutaneous manifestations of leukaemias, lymphomas, multiple myeloma (MM), and blastic plasmacytoid dendritic cell neoplasm (BPDN) and make a review of the literature. METHODS Data from 49 patients diagnosed with secondary cutaneous infiltration of systemic haematological neoplasms over the last 10 years in a tertiary dermatology centre were retrospectively collected, and clinical-evolutive features were analysed. RESULTS Most cases were lymphoma (44.9%, n = 22), followed by leukaemia cutis (38.8%, n = 19), secondary plasmacytoma (10.2%, n = 5) and BPDN (6.1%, n = 3). Nodules were the predominant type of lesion, and most patients presented with multiple (≥3) lesions. In 51% (n = 25) of cases, cutaneous infiltration was detected before the diagnosis of the underlying malignancy. The patients in diverse nosological groups did not differ in terms of survival (P = 0.052). CONCLUSIONS We recognise the clinical heterogeneity of specific cutaneous infiltrates. The high proportion of cases in which skin involvement was key to the diagnosis of systemic malignancy emphasises the role of the dermatologist in recognising and correctly managing these patients.
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Affiliation(s)
- Rebeca Calado
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Relvas
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Francisca Morgado
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - José Carlos Cardoso
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Oscar Tellechea
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
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18
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Sittenfeld SMC, Murray E, Guo B, Tendulkar R, Xia P, Shah C. Treatment of diffuse cutaneous metastases from breast cancer. Breast J 2020; 26:2444-2446. [PMID: 32918340 DOI: 10.1111/tbj.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah M C Sittenfeld
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric Murray
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bingqi Guo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul Tendulkar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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19
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Faye PM, Cagniet A, Abousarhan F, Jolidon C. Atypical localization of colorectal cancer metastasis one case and literature review. Int J Surg Case Rep 2020; 77:18-21. [PMID: 33137665 PMCID: PMC7610026 DOI: 10.1016/j.ijscr.2020.10.073] [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: 09/23/2020] [Revised: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION colorectal cancer is a public health challenge in France. Cutaneous metastases are rare but they give evidence of poor prognosis. PRESENTATION OF CASE 88 years old female patient, with a previous history of hysterectomy, venous thrombosis outcomes of ankle fracture and stable multiple sclerosis without treatment. She came to emergency with peritonitis. CT scan showed a pneumoperitoneum, and a transverse colonic mass. A laparotomy was performed. This revealed a perforation of caecum, and an obstructive tumor of transverse colon. An extended right semi-colectomy was performed to remove both the perforate caecum and the tumor. The patient was discharged on the 7th post-operative day. Examination confirm an adenocarcinoma pT3N0Mx. At follow up, a nodule was found on her forehead. The biopsy showed a metastasis of colon adenocarcinoma. A surgical resection was performed. To date the patient is well with no evidence of recurrent disease. CONCLUSION Cutaneous metastases are rare and there are no recommendations for their treatment. Surgical resection is the best choice, but radiotherapy may be an alternative.
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20
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O'Neill G, Straight C, Helm K. A painful rash on a white woman. JAAD Case Rep 2020; 6:1095-1097. [PMID: 33005713 PMCID: PMC7511648 DOI: 10.1016/j.jdcr.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Padden S, Abraham E, Viscosi E, Habin K, Lundquist D. Cutaneous Metastases: A Case Study on Clinical Care for Patients. Clin J Oncol Nurs 2020; 24:320-323. [DOI: 10.1188/20.cjon.320-323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Ruiz SJ, Al Salihi S, Prieto VG, Nagarajan P, Tetzlaff MT, Curry JL, Ivan D, Torres-Cabala CA, Aung PP. Unusual cutaneous metastatic carcinoma. Ann Diagn Pathol 2019; 43:151399. [PMID: 31675677 DOI: 10.1016/j.anndiagpath.2019.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 02/08/2023]
Abstract
Most of metastatic tumors to the skin are from primary tumors of the breast, lung, or from melanoma; metastases to the skin from primary carcinomas at other sites are rare. Cutaneous metastases of visceral carcinomas most often occur in patients with advanced disease, and are associated with a poor prognosis. We report 6 cases of nonmammary, nonpulmonary carcinoma metastatic to the skin. Most patients were elderly with advanced disease at the time of diagnosis of skin metastasis. The primary tumor sites included the thyroid, esophagus, biliary tract, ovary, and prostate. Awareness of these rare cases of metastasis to the skin will help pathologists and clinicians make the correct diagnosis.
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Affiliation(s)
- Sory J Ruiz
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Suhair Al Salihi
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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23
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Sakanaka K, Ishida Y, Mizowaki T. A Case Report of Locally Advanced Anal Cancer with Solitary Cutaneous Nodular Metastasis in the Ipsilateral Labia Majora Treated with Definitive Chemoradiotherapy. Case Rep Oncol 2019; 12:721-727. [PMID: 31607890 PMCID: PMC6787419 DOI: 10.1159/000503171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
Cutaneous metastasis from anal cancer is rare at the initial diagnosis. There is a dearth of information on definitive treatment for anal cancer with cutaneous metastasis. We report the case of a 63-year-old female with locally advanced anal cancer and solitary cutaneous nodular metastasis in the right labia majora identified at the initial diagnosis that was successfully treated with definitive chemoradiotherapy. She arrived at our hospital with complaints of an enlarging perineal itching nodule. Genital and rectal examination detected an anal tumor with perineal and rectal invasion. The biopsy specimen indicated it was a squamous cell carcinoma that was accompanied by right inguinal and external iliac lymph nodal metastases and solitary cutaneous nodular metastasis in the ipsilateral labia majora. She was diagnosed with anal cancer, clinical T3N1M1, stage IV (UICC-TNM 7th). She had good performance status and effective organ function. She received definitive chemoradiotherapy with irradiation fields that included the primary tumor, pelvic lymph nodal metastases, and solitary cutaneous genital metastasis. After completing the planned treatment, all tumors vanished without recurrences at 42 months after treatment. In conclusion, patients with locally advanced anal cancer may suffer genital cutaneous metastasis that develops with lymphatic drainage from the anus to the inguinal lymph nodes. Anal cancer with solitary genital cutaneous nodular metastasis can be considered as a local-regional disease and can be treated with chemoradiotherapy. Chemoradiotherapy achieved a cure in our case.
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Affiliation(s)
- Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Ishida
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
Cutaneous metastasis portends a poor prognosis. Therefore, a high clinical index of suspicion is necessary so that a clinician knows how to recognize the presentation of a cutaneous metastasis, while the pathologist must know the appropriate stains to order. In this review, the authors summarize the common and uncommon ways that these tumors will present. Frequently a metastatic cancer will present as a firm red nodule or as a plaque, ulcer, or papule. Less commonly they will present with a clinical clue that can alert a clinician to a likely diagnosis; these manifestations include alopecic, vesicular, blue color, sclerodermoid, acrochordon-, or pellagra-like.
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Affiliation(s)
- Evan Alexander Choate
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexander Nobori
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ezralow Tower, Suite 5301, Los Angeles, CA 90033-9174, USA.
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25
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Campana LG, Miklavčič D, Bertino G, Marconato R, Valpione S, Imarisio I, Dieci MV, Granziera E, Cemazar M, Alaibac M, Sersa G. Electrochemotherapy of superficial tumors - Current status:: Basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol 2019; 46:173-191. [PMID: 31122761 DOI: 10.1053/j.seminoncol.2019.04.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
Treatment of superficial tumors with electrochemotherapy (ECT) has shown a steep rise over the past decade and indications range from skin cancers to locally advanced or metastatic neoplasms. Based on reversible electroporation, which is a physical method to achieve transient tumor cell membrane permeabilization by means of short electric pulses, ECT increases cellular uptake of bleomycin and cisplatin and their cytotoxicity by 8,000- and 80-fold, respectively. Standard operating procedures were established in 2006 and updated in 2018. Ease of administration, patient tolerability, efficacy across histotypes, and repeatability are peculiar advantages, which make standard ECT (ie, ECT using fixed-geometry electrodes) a reliable option for controlling superficial tumor growth locally and preventing their morbidity. Consolidated indications include superficial metastatic melanoma, breast cancer, head and neck skin tumors, nonmelanoma skin cancers, and Kaposi sarcoma. In well-selected patients with oropharyngeal cancers, ECT ensures appreciable symptom control. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, and some noncancerous skin lesions (keloids and capillary vascular malformations). Repeatability and integration with other oncologic therapies allow for consolidation of response and sustained tumor control. In this review, we present the basic principles of ECT, recently updated operating procedures, anesthesiological management, and provide a synthesis of the efficacy of standard ECT across histotypes.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Ilaria Imarisio
- Medical Oncology Unit, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Vittoria Dieci
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Medical Oncology-2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mauro Alaibac
- Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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27
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Epidermotropic poorly differentiated adenocarcinoma of colon presenting as a diffuse erythematous petechial rash. JAAD Case Rep 2019; 5:113-115. [PMID: 30671523 PMCID: PMC6330357 DOI: 10.1016/j.jdcr.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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McClees SF, Duncan JR, Ceilley R, Milless TL, Elewski BE. Isolated Nail Dystrophy: An Unlikely Presentation of Metastatic Renal Cell Carcinoma. Skin Appendage Disord 2018; 5:177-180. [PMID: 31049343 DOI: 10.1159/000495121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Metastasis of any malignancy to the nail unit is uncommon, and only a handful of cases of subungual renal cell carcinoma (RCC) metastasis have been reported. We describe a case of isolated nail dystrophy that proved to be the presenting symptom of a previously undetected RCC. In a patient presenting with a subungual lesion, tumor metastasis to the nail unit should be included in the clinical differential diagnosis in both oncology patients and previously cancer-free individuals, as a subungual metastasis may be the first indication of a clinically silent visceral malignancy.
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Affiliation(s)
- Sarah F McClees
- School of Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - James Robert Duncan
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama, USA
| | | | | | - Boni E Elewski
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama, USA
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29
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Sehrawat A, Kotwal SA, Parthasarathy KM. Metastatic Dermatosis in Breast Carcinoma on Adjuvant Trastuzumab: Is Skin a Sanctuary Site in Human Epidermal Growth Factor Receptor-2-Amplified Disease? Indian J Dermatol 2018; 63:424-426. [PMID: 30210167 PMCID: PMC6124245 DOI: 10.4103/ijd.ijd_234_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cutaneous metastasis (CM) from internal malignancies is commonly seen. Sometimes, skin metastases can be the first sign of advanced cancer or an indicator of cancer recurrence. Cases of breast cancer with cutaneous progression after or during trastuzumab therapy have been described in the past, frequently associated with systemic disease progression. However, CM during adjuvant trastuzumab therapy is very rare. It has been hypothesized that cancer cells located in the skin survive and take proliferative advantage by virtue of an immune-tolerance mechanism that hampers trastuzumab-mediated antibody-dependent cell-mediated cytotoxicity. We describe a case of human epidermal growth factor receptor-2-overexpressing breast cancer presenting with diffuse CM during adjuvant trastuzumab therapy.
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Affiliation(s)
- Amit Sehrawat
- From the Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
- Address for correspondence: Dr. Amit Sehrawat, Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, Vasundhara Enclave, New Delhi - 110 096, India. E-mail:
| | - Sumedha A. Kotwal
- Department of Pathology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - K. M. Parthasarathy
- From the Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
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30
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Espinosa Aunión R, Ramírez Ruda CA, Rodríguez López C, Curiel García T, García Saénz JÁ, López López R. Experience with eribulin in patients with breast cancer and cutaneous metastases: case studies. Future Oncol 2018; 14:37-44. [PMID: 29611759 DOI: 10.2217/fon-2017-0360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Skin localization occurs in about 25% of women with metastatic breast cancer and represents a major therapeutic challenge. Although clinical literature on response of cutaneous metastases to chemotherapy is scarce, good response to eribulin has been reported. Herein, the clinical courses of three women with skin lesions secondary to metastatic breast cancer are described. The first patient achieved a complete clinical response in skin metastases with good tolerability to fourth-line eribulin (progression-free survival [PFS]: 8.5 months). In the second case, eribulin administered as fifth-line chemotherapy produced an objective response and PFS of 6 months with good tolerability. The third patient also received eribulin in the fifth line and had a visible skin response from the first administration (PFS: 5 months).
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Affiliation(s)
| | | | - Carmela Rodríguez López
- Medical Oncology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | - Teresa Curiel García
- Medical Oncology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | | | - Rafael López López
- Medical Oncology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
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31
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Torraca PDFS, Castro BCD, Hans G, Lima AMD. Cutaneous metastases in a patient with no previous diagnosis of cancer: diagnostic challenge. An Bras Dermatol 2018; 92:47-49. [PMID: 29267444 PMCID: PMC5726675 DOI: 10.1590/abd1806-4841.20175870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/26/2016] [Indexed: 12/26/2022] Open
Abstract
On rare occasions, skin lesions are the first local of metastatic manifestation
of internal malignancies. In case of no previous diagnosis of these tumors, the
approach of suspicious skin lesions becomes a challenge, especially in
differentiating cutaneous metastases and adnexal primary neoplasms. Currently,
besides epidemiologic, dermoscopic and histopathologic aspects, the evaluation
also integrates immunohistochemical exams and cell markers such as p40 and p63,
highly specific for skin metastases. This article describes the case of
cutaneous metastases as the sole obvious sign of breast cancer in a previously
asymptomatic woman. The diagnosis was made by the finding of neoplastic cells in
the dermis and immunohistochemistry compatible with ductal carcinoma.
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Affiliation(s)
- Pedro de Freitas Silva Torraca
- Department of Internal Medicine of the Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul (Famed-UFMS) - Campo Grande (MS), Brazil
| | - Bruna Corrêa de Castro
- Dr. Günter Hans Department of Dermatology, at Hospital Universitário da Universidade Federal de Mato Grosso do Sul (NHU-UFMS) - Campo Grande (MS), Brazil
| | - Günter Hans
- Dr. Günter Hans Department of Dermatology, at Hospital Universitário da Universidade Federal de Mato Grosso do Sul (NHU-UFMS) - Campo Grande (MS), Brazil
| | - Alexandre Moretti de Lima
- Dr. Günter Hans Department of Dermatology, at Hospital Universitário da Universidade Federal de Mato Grosso do Sul (NHU-UFMS) - Campo Grande (MS), Brazil
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Affiliation(s)
- Katie Spencer
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
| | - Rhona Parrish
- Garforth Medical Centre, Garforth, Leeds LS25 1HB, UK
| | - Rachael Barton
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham HU16 5JQ, UK
| | - Ann Henry
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
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33
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Mok ZR, Yong AMY, Leung AJ, Tan KB, Aw DCW. Cutaneous metastasis: experience from a tertiary healthcare institution in Singapore. Int J Dermatol 2017; 56:1497-1498. [PMID: 28833072 DOI: 10.1111/ijd.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Zhun R Mok
- National University Hospital, Singapore City, Singapore
| | | | - An J Leung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kong B Tan
- National University Hospital, Singapore City, Singapore
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34
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Affiliation(s)
- Daniel Weinberg
- Department of Medicine (Weinberg, Syed), Salford Royal NHS Foundation Trust, Salford, UK; Faculty of Biology, Medicine & Health (Syed), The University of Manchester, Manchester, UK
| | - Akheel A Syed
- Department of Medicine (Weinberg, Syed), Salford Royal NHS Foundation Trust, Salford, UK; Faculty of Biology, Medicine & Health (Syed), The University of Manchester, Manchester, UK
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Breast Cancer Metastasis Misdiagnosed as an Angiokeratomatous Eruption. An Infrequent Presentation. Case Report. Am J Dermatopathol 2016; 38:302-4. [PMID: 26999341 DOI: 10.1097/dad.0000000000000487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cutaneous metastases represent 2% of all metastases. Breast cancer is the most common cause of skin metastases. Schwartz described 8 types of cutaneous breast metastases; one uncommon form is carcinoma telangiectodes (CT), which may resemble angiosarcoma or lymphangioma circumscriptum. However, there are no reports of CT misdiagnosed as eruptive angiokeratomas. CASE REPORT The authors describe the clinical, histopathologic, and immunohistochemical features of a unique case of CT. Clinical examination revealed an itchy, dark blue-reddish scaly papular eruption that resembled angiokeratomas. The papules were grouped in a zosteriform pattern on the right chest. A biopsy of the papules revealed intravascular thrombi of neoplastic cells and erythrocytes. The neoplastic cells were pleomorphic and with mitotic figures. Immunohistochemical analysis revealed expression of HER-2-neu in neoplastic cells but negative for estrogen and progesterone receptors. The involved vessels were positive for CD31 and negative for podoplanin. This immunoprofile demonstrated intravascular spread of aggressive breast carcinoma. CONCLUSION CT is an uncommon form of cutaneous metastasis from breast carcinoma with less than 10 cases described in the literature. There are no previous reported cases of CT mimicking angiokeratomas, although lymphangioma circumscriptum-like lesion may occasionally resemble angiokeratomas. A unique clinical presentation of CT is described.
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Lin TH, Hsieh YC, Win KT, Lai FJ, Feng YH, Lee WY, Chuang SS. Multiple abdominal papules and plaques and mild lymphocytosis. Int J Dermatol 2015; 55:845-8. [PMID: 26463720 DOI: 10.1111/ijd.13078] [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: 03/26/2015] [Revised: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Tsung-Hsien Lin
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yen-Chuan Hsieh
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Khin Than Win
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Feng-Jie Lai
- Department of Dermatology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yin-Hsun Feng
- Division of Hematology-Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wen-Ying Lee
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pathology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pathology, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
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38
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Skin Manifestations of Internal Disease in Older Adults. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fragulidis GP, Vezakis A, Derpapas MK, Michalaki V, Tsagkas A, Polydorou AA. Cutaneous Metastatic Adenocarcinoma of the Colon to the Scalp. World J Oncol 2015; 6:304-307. [PMID: 29147421 PMCID: PMC5649951 DOI: 10.14740/wjon862w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/11/2022] Open
Abstract
Cutaneous metastases from colorectal cancer are relatively uncommon presenting in fewer than 5% of patients but they are very important to recognize as they signify disseminated disease and poor prognosis. We describe a case a 62-year-old patient diagnosed with scalp metastasis during his systemic chemotherapy treatment for a colorectal carcinoma stage IVb who underwent excisional biopsy of the metastatic lesion. The identification of cutaneous metastases from colorectal cancer can radically alter therapeutic plans as they typically indicate a wide spread disease. Although they can be observed at any stage of malignancy, early recognition can lead to accurate and prompt diagnosis and timely treatment.
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Affiliation(s)
- Georgios P Fragulidis
- The 2nd Department of Surgery, Aretaieio Hospital, University of Athens Medical School, Greece
| | - Antonios Vezakis
- The 2nd Department of Surgery, Aretaieio Hospital, University of Athens Medical School, Greece
| | - Michael K Derpapas
- The 2nd Department of Surgery, Aretaieio Hospital, University of Athens Medical School, Greece
| | - Vassiliki Michalaki
- Department of Oncology, Aretaieio Hospital, University of Athens Medical School, Greece
| | - Athanassios Tsagkas
- Department of Pathology, Aretaieio Hospital, University of Athens Medical School, Greece
| | - Andreas A Polydorou
- The 2nd Department of Surgery, Aretaieio Hospital, University of Athens Medical School, Greece
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40
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Rueth NM, Cromwell KD, Cormier JN. Long-term follow-up for melanoma patients: is there any evidence of a benefit? Surg Oncol Clin N Am 2015; 24:359-77. [PMID: 25769718 DOI: 10.1016/j.soc.2014.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As the incidence of melanoma and the number of melanoma survivors continues to rise, optimal surveillance strategies are needed that balance the risks and benefits of screening in the context of contemporary resource use. Detection of recurrences has important implications for clinical management. Most current surveillance recommendations for melanoma survivors are based on low-level evidence with wide variations in practice patterns and an unknown clinical impact for the melanoma survivor.
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Affiliation(s)
- Natasha M Rueth
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA.
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A clinicopathological and immunohistochemical correlation in cutaneous metastases from internal malignancies: a five-year study. J Skin Cancer 2014; 2014:793937. [PMID: 25215239 PMCID: PMC4158475 DOI: 10.1155/2014/793937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/30/2014] [Accepted: 08/14/2014] [Indexed: 11/29/2022] Open
Abstract
Cutaneous metastases from internal malignancies are uncommon and occur in 0.6%–10.4% of all patients with cancer. In most cases, cutaneous metastases develop after the initial diagnosis of the primary internal malignancy and late in the course of the disease. Skin tumors are infrequent in Asian population and cutaneous metastases are quite rare. Cutaneous metastases carry a poor prognosis with average survival of few months. In the present five-year study 1924 malignant tumors were screened which included only nine cases of cutaneous metastatic deposits. A wide range of site and clinical presentations including nodules, plaques, and ulcers was noted. Histopathological findings were significant and corresponded with the primary internal malignancy. Cutaneous metastases from breast carcinoma (44.4%) were the most common finding followed by non-Hodgkin lymphoma and renal cell carcinoma (22.2% each) and carcinoma cervix (11.1%). The aim of our study is to classify the cutaneous metastases and to evaluate their clinicopathologic and immunohistochemical correlation with the primary tumor.
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Her-2 positive gastric cancer presented with thrombocytopenia and skin involvement: a case report. Case Rep Oncol Med 2014; 2014:194636. [PMID: 25045559 PMCID: PMC4090488 DOI: 10.1155/2014/194636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/10/2014] [Indexed: 01/13/2023] Open
Abstract
Gastric cancer is the 5th most frequent cancer around the world and the 3rd most frequent reason of deaths due to cancer. Every year, about 1 million new cases are taking place, with varying geographical distribution. Gastric cancer is often metastatic to liver, lungs, and bones in hematogenous way, to peripheral lymph nodes in lymphogenous way, and to peripheral tissues in adjacency way, yet bone marrow (BM) and cutaneous metastasis are quite seldom. Pancytopenia is a more frequent finding identified in BM metastasis of solid organ cancers, and isolated thrombocytopenia is less often. The human epidermal growth factor 2 (HER-2) is positive in gastric cancer at a rate of 7–34%. Here, we have presented our HER-2 positive gastric cancer incident which presented with BM and cutaneous metastasis, and has no 18F-fluoro-2-deoxi-D-glucose (FDG) involvement except bone metastases.
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Wong CYB, Helm MA, Kalb RE, Helm TN, Zeitouni NC. The presentation, pathology, and current management strategies of cutaneous metastasis. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:499-504. [PMID: 24251266 PMCID: PMC3818821 DOI: 10.4103/1947-2714.118918] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Skin metastases are rare in the routine clinical practice of dermatology, but are of major clinical significance because they usually indicate advanced disease. We reviewed the literature on skin metastasis regarding recent trends in clinical presentation and diagnosis of the most common cutaneous lesions. An extensive literature review was conducted using PubMed from May 26, 2011 to July 16, 2013 relating cutaneous metastases. Articles chosen for reference were queried with the following prompts: “Cutaneous metastases”, “clinical presentation”, “histological features”, and “immunohistochemistry”. Further searches included “treatment” and “management” options for “metastatic breast”, “metastatic colorectal”, “metastatic melanoma”, “metastatic lung”, and “hematologic cancers.” We also reviewed the literature on the current management of melanoma as a model for all cutaneous metastatic disease. Our own clinical findings are presented and compared to the literature. Additionally, we highlight the most useful immunohistochemical studies that aid in diagnoses. Several novel therapies and combination therapies such as electrochemotherapy, vemurafenib, and imiquimod will be discussed for palliative treatment of cancers that have been found to improve cutaneous lesions. We review these notable findings and developments regarding skin metastases for the general dermatologist.
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Affiliation(s)
- Christina Yin Bin Wong
- Department of Dermatology, Roswell Park Cancer Institute, University at Buffalo, Buffalo, New York, USA
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Polednak AP. Inaccuracies in oral cavity-pharynx cancer coded as the underlying cause of death on U.S. death certificates, and trends in mortality rates (1999-2010). Oral Oncol 2014; 50:732-9. [PMID: 24862544 DOI: 10.1016/j.oraloncology.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/04/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To enhance surveillance of mortality from oral cavity-pharynx cancer (OCPC) by considering inaccuracies in the cancer site coded as the underlying cause of death on death certificates vs. cancer site in a population-based cancer registry (as the gold standard). METHODS A database was used for 9 population-based cancer registries of the Surveillance, Epidemiology and End Results (SEER) Program, including deaths in 1999-2010 for patients diagnosed in 1973-2010. Numbers of deaths and death rates for OCPC in the SEER population were modified for apparent inaccuracies in the cancer site coded as the underlying cause of death. RESULTS For age groups <65 years, deaths from OCPC were underestimated by 22-35% by using unmodified (vs. modified) numbers, but temporal declines in death rates were still evident in the SEER population and were similar to declines using routine mortality data for the entire U.S. population. Deaths were underestimated by about 70-80% using underlying cause for tonsillar cancers, strongly associated with human papillomavirus (HPV) infection, but a lack of decline in death rates was still evident. CONCLUSION Routine mortality statistics based on underlying cause of death underestimate OCPC deaths but demonstrate trends in OCPC death rates that require continued surveillance in view of increasing incidence rates for HPV-related OCPC.
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Affiliation(s)
- Anthony P Polednak
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, United States (Retired).
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Cleary J, Ddungu H, Distelhorst SR, Ripamonti C, Rodin GM, Bushnaq MA, Clegg-Lamptey JN, Connor SR, Diwani MB, Eniu A, Harford JB, Kumar S, Rajagopal MR, Thompson B, Gralow JR, Anderson BO. Supportive and palliative care for metastatic breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast 2013; 22:616-27. [PMID: 23972474 DOI: 10.1016/j.breast.2013.07.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/23/2013] [Indexed: 12/25/2022] Open
Abstract
Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support.
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Affiliation(s)
- James Cleary
- University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA
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