Multiple Cutaneous Metastases as Initial Presentation in Advanced Colon Cancer

Cutaneous Metastasis from Colorectal Cancer: Making Light on an Unusual and Misdiagnosed Event

Cutaneous metastasis from solid tumors is a rare event and usually represents a late occurrence in the natural history of an advanced visceral malignancy. Rarely, cutaneous metastasis has been described in colorectal cancer patients. The most frequent cutaneous site of colorectal metastasis is the surgical scar in the abdomen following the removal of the primary malignancy, followed by the extremities, perineum, head, neck, and penis. Metastases to the thigh and back of the trunk are anecdotical. Dermatological diagnosis of cutaneous metastasis can be quite complex, especially in unusual sites, such as in the facial skin or thorax and in cases of single cutaneous lesions since metastasis from colorectal cancer is not usually the first clinical hypothesis, leading to misdiagnosis. To date, due to the rarity of cutaneous metastasis from colorectal cancer, little evidence, most of which is based on case reports and very small case series, is currently available. Therefore, a better understanding of the clinic-pathological characteristics of this unusual metastatic site represents an unmet clinical need. We present a large series of 29 cutaneous metastases from colorectal cancer with particular concerns regarding anatomic localization and the time of onset with respect to primitive colorectal cancer and visceral metastases.

Cutaneous Metastasis in the Setting of Both Colon and Breast Primary Malignancies

Colorectal cancer (CRC) is the third most diagnosed cancer in the United States, and many patients unfortunately have metastases at the time of their diagnosis. Cutaneous metastases of CRC have been reported in few journals and primarily as case reports due to their rarity. Here, we present the case of an 83-year-old woman with recently resected colon cancer, T4aN1bMx stage IIIB. She presented to our clinic for evaluation of a right midback mass, and a punch biopsy revealed dermal involvement by invasive, poorly differentiated carcinoma with epidermoid features. The mass was excised, and we ordered a PET scan in search of the primary tumor, which at that time was suspected to be of skin cancer origin. Surprisingly, this revealed a second malignancy triple-negative invasive ductal carcinoma of the left breast. The back mass stained positive for CK20, which was compatible with a metastasis from a colonic primary. After initially declining adjuvant therapy, the patient completed one cycle of capecitabine and oxaliplatin, which she tolerated poorly. She continued to further decline, developed widespread cutaneous metastases, and went home on hospice. Cutaneous lesions are an exceedingly rare site of metastasis for colon adenocarcinoma, and their clinical presentation can vary widely. It is important for providers to investigate any new skin lesion in a patient with a recent or remote history of malignancy, even if there were no sites of distant metastasis at initial diagnosis.

Cutaneous metastasis of a colon adenocarcinoma presenting as an unusual manifestation: a report of one case

Colorectal cancer has a low probability of metastasizing to the skin, usually < 6%, and the common sites of metastasis are the liver and lungs. Skin metastases usually occur within 2 years of the discovery of the primary tumor. Here we report a case in which the skin lesions were mainly characterized by unilateral scattered papules and "fake blisters". The patient was initially misdiagnosed with lymphoma and was ultimately diagnosed with metastatic colorectal cancer through pathology.

A cutaneous metastasis of unresectable rectal adenocarcinoma: A case report and literature review

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Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer death in the world.

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Approximately, 0.8% of patients will present with skin lesion as the first sign of a silent internal malignancy as skin metastasis without visceral metastasis is rare in CRC.

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A comprehensive literature review (including clinical features of patients, management, and outcome) covering all reported cases of cutaneous metastasis secondary to rectal cancer was included for better understanding of the disease.

Background

Colorectal cancer is ranked third among the most commonly diagnosed malignancies and fourth among the leading causes of cancer death in the world. However, only a few case reports are found in the literature regarding skin metastasis originating from rectal cancer, which usually shows widespread disease and poor prognosis. Approximately, 0.8% of the patients will have skin lesion as the first indication of a silent internal malignancy, which is rare.

Case report

We report a complicated case of a 45-year-old male patient who referred to our highly specialized governmental hospital for diversion loop colostomy as well as biopsies of rectal and inguinal skin areas followed by palliative radiation therapy to the pelvis. Histopathological exam of rectal biopsies revealed moderately differentiated rectal adenocarcinoma, while the skin of the right inguinal area showed metastatic cutaneous rectal adenocarcinoma. Unfortunately, palliative radiation therapy was not started as the patient passed away secondary to respiratory failure which ended by cardiopulmonary arrest.

Conclusion

A patient who is having new or evolving skin lesions with an oncology history should be well investigated as cutaneous metastasis is a strong possibility.

Cutaneous and breast metastasis from colorectal adenocarcinoma: A rare case report

Synchronous breast and cutaneous metastases from colorectal adenocarcinoma as the initial clinical manifestation, without visceral metastases, are extremely rare. We herein report the case of a 68-year-old female patient who presented with pruritic skin lesions and a breast lump 6 years after abdominoperineal resection of colorectal adenocarcinoma. Such cases can be easily misdiagnosed as cutaneous metastasis from breast cancer. However, the management of colorectal metastases differs from that of primary breast cancer, and mastectomy may be unnecessary. Timely and accurate diagnosis requires a high level of suspicion, thorough medical clinical history and biopsy followed by immunohistological examination. Specific immunohistochemical markers, such as cytokeratin (CK)7, CK20 and CDX2, may help differentiate between primary breast and metastatic colorectal adenocarcinoma.