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Valentini R, Grant-Kels JM, Falcone M, Stewart CL. Merkel cell carcinoma and the eye. Clin Dermatol 2024; 42:381-389. [PMID: 38325726 DOI: 10.1016/j.clindermatol.2024.01.010] [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: 02/09/2024]
Abstract
Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine tumor with a poor five-year survival rate. Yearly cases have risen nearly 350% since the early 1980s, and these are predicted to increase as the overall US population ages. MCC of the eyelid is uncommon and can be misdiagnosed as other benign inflammatory and neoplastic eyelid disorders. Although MCC of the head and neck is often more aggressive than it is at other sites, eyelid MCC shows a lower disease-specific mortality rate. A biopsy is essential for accurate diagnosis, including an immunohistochemical panel of CK20 and TTF-1, although other markers may be necessary. Staging can be assessed clinically through physical examination findings and imaging and/or pathologically with sentinel lymph node biopsy or fine-needle aspiration. Pathologic staging more accurately predicts the prognosis. Eyelid MCC treatments include Mohs micrographic surgery to allow for complete clearance and adequate reconstruction of lost tissue, followed by adjuvant radiotherapy. In advanced disease, immunotherapies are preferred over traditional chemotherapy and are a subject of ongoing research.
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Affiliation(s)
- Rodolfo Valentini
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Madina Falcone
- Department of Surgery, Division of Ophthalmology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Campbell L Stewart
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
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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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Sakhri S, Zemni I, Ayadi MA, Naija L, Boujelbene N, Ben Dhiab T. Cutaneous metastasis as a first presentation of lung carcinoma: a case series. J Med Case Rep 2023; 17:315. [PMID: 37481539 PMCID: PMC10363314 DOI: 10.1186/s13256-023-04029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/24/2023] Open
Abstract
INTRODUCTION Cutaneous metastases (CM) revealing lung carcinoma are extremely rare, accounting for 0.8%. The diagnosis is guided by histology and immunohistochemistry. Treatment is palliative. The prognosis is poor. CASE PRESENTATION This is a retrospective study of the available clinical and histological records of four North African patients with CM revealing lung cancer treated at our institute between 2004 and 2010. Three men and one woman were registered. The mean age was 54.5 years (38-74 years). Two patients had primary adenocarcinoma, one patient had small cell carcinoma and one had squamous cell carcinoma. Treatment was based on chemotherapy in two cases and antalgic radiotherapy in two cases, one patient underwent surgical resection as the lesion was infected. The overall survival after diagnosis was between one and four months. CONCLUSIONS A skin nodule can be the first symptom revealing lung cancer. A rare clinical presentation that should not be taken for a benign nodule, the biopsy and histological study with immunohistochemistry confirm the diagnosis.
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Affiliation(s)
- Saida Sakhri
- Department of Surgical Oncology,, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Zemni
- Department of Surgical Oncology,, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
- LMBA (LR03ES03), Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Ali Ayadi
- Department of Surgical Oncology,, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- LMBA (LR03ES03), Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Lamia Naija
- Department of Surgical Oncology,, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nadia Boujelbene
- LMBA (LR03ES03), Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Pathology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tarek Ben Dhiab
- Department of Surgical Oncology,, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Tsakiri K, Ouranos K, Nikolaidou C, Papadopoulos S, Andreadou A, Mouloudi E, Massa E. Cutaneous lesions in a COVID-19 patient leading to a surprising diagnosis. Breathe (Sheff) 2023; 19:220233. [PMID: 37378064 PMCID: PMC10292768 DOI: 10.1183/20734735.0233-2022] [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] [Received: 10/05/2022] [Accepted: 01/23/2023] [Indexed: 06/29/2023] Open
Abstract
Differential diagnosis of skin lesions is broad. Cutaneous metastases should always be considered in the appropriate clinical and laboratory context to ensure accurate diagnosis. https://bit.ly/400Msre.
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Affiliation(s)
- Kalliopi Tsakiri
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
- Equally contributed to this paper
| | - Konstantinos Ouranos
- 4th Medical Department, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Equally contributed to this paper
| | - Christina Nikolaidou
- Department of Histopathology, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Savvas Papadopoulos
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Anna Andreadou
- 3rd Oncology Clinic of Theagenio Hospital, Thessaloniki, Greece
| | - Eleni Mouloudi
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Eleni Massa
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
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Chisenga R, Adenwala T, Kim W, Mujuni D, Samuel R. Squamous cell carcinoma of the lung presenting as a fungating ulcerated skin lesion: a case report. J Med Case Rep 2022; 16:172. [PMID: 35468849 PMCID: PMC9040228 DOI: 10.1186/s13256-022-03352-4] [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: 11/01/2021] [Accepted: 03/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Our patient presents with a novel presentation of a fungated ulcerated skin lesion as the initial presentation of lung cancer. The literature describes skin metastases from lung cancer as nodular, papular, and zosteriform. Our case is a fungating ulcerated skin lesion which is not widely reported in literature. There is a still a need for more data on the clinical presentation and prognosis of such cases as it will elucidate the diagnostic challenges and treatment management. Case presentation We present a case of a 55 year old Caucasian male with a 60-pack-year smoking history initially presenting with a nodule on his right upper back that quickly fungated and ulcerated requiring surgical excision. Biopsy of both the skin lesion and the lung mass confirmed squamous cell carcinoma (SCC) and the lung mass being the primary tumor. The patient’s clinical and functional status severely declined during his hospital stay and was later discharged to hospice without therapeutic intervention. He later expired a month after hospice stay. Conclusions Although uncommon, this case clearly illustrates that skin metastases can be the initial finding of primary lung cancer and that not all patients with lung cancer will present with bronchopulmonary symptoms. It also illustrates that a fungating ulcerated lesion can be the initial presentation of lung cancer in addition to nodular, papular, and zosteriform presentations noted in the literature.
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Affiliation(s)
- Rose Chisenga
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Tasneem Adenwala
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - William Kim
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
| | - Daniel Mujuni
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Rachel Samuel
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Siddiqa A, Haider A, Mehmood M, Bapna M. A 58-Year-Old Man with a Painful Gluteal Mass as the First Presentation of Metastatic Adenocarcinoma of the Lung. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928122. [PMID: 33664218 PMCID: PMC7942208 DOI: 10.12659/ajcr.928122] [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] [Indexed: 11/17/2022]
Abstract
Patient: Male, 58-year-old Final Diagnosis: Metastatic lung adenocarcinoma Symptoms: Gluteal mass Medication:— Clinical Procedure: — Specialty: Oncology • Pulmonology
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Affiliation(s)
- Ayesha Siddiqa
- Department of Medicine, BronxCare Health Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Asim Haider
- Department of Medicine, BronxCare Health Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Maham Mehmood
- Department of Medicine, BronxCare Health Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Monica Bapna
- Department of Medicine, BronxCare Health Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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Wang X, Wang H, Jia B, He F, Yuan Y, Zhang W. Cutaneous Metastasis as the First Presentation of Non-Small-Cell Lung Cancer with a BRAF Mutation: A Case Report. Onco Targets Ther 2021; 13:13143-13149. [PMID: 33380804 PMCID: PMC7767729 DOI: 10.2147/ott.s282593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Cutaneous metastasis from a primary visceral malignancy is a relatively uncommon clinical manifestation that occurs as an initial presentation in 1% to 12% of patients with internal malignancies. Additionally, cutaneous metastases are often late signs of an internal malignancy, and in very rare cases they may occur at the same time or before the primary cancer has been detected. Metastasis to the skin has a poor prognosis and is often a sign of widespread malignant tumors. In the present study, we report a 72-year-old male who presented with multiple rapidly growing subcutaneous nodules. Positron emission tomography-computed tomography (PET-CT) revealed a hypermetabolic concentration of radiotracer in the left lower lung and multiple organ metastases associated with multiple skin masses. Biopsy of one of the skin nodules and gene detection indicated metastatic adenocarcinoma consistent with a primary lung origin with a BRAF mutation. BRAF mutations are emerging therapeutic targets in non-small-cell lung cancer (NSCLC), as they are present in 2–4% of NSCLC cases. To the best of our knowledge, this is the first case report to show that BRAF-mutant lung adenocarcinoma can be associated with cutaneous metastasis. Early diagnosis and individualized treatment strategies may prolong patient survival.
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Affiliation(s)
- Xuejun Wang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongmei Wang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Baochang Jia
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Fang He
- Department of Radiation Oncology, Zhongshan City People's Hospital, Zhongshan, Guangdong Province, People's Republic of China
| | - Yawei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Weijun Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Cutaneous Metastases from Lung Adenocarcinoma. Case Rep Dermatol Med 2020; 2020:8880604. [PMID: 32850155 PMCID: PMC7441430 DOI: 10.1155/2020/8880604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Cutaneous metastases are unusual presenting symptoms of lung cancer. Therefore, they are prone to be misdiagnosed and missed. The report describes a case of a forty-nine-year-old female with painful zosteriform rashes showing multiple vesicle-like papules localized on the left breast for 10 days. The patient had been diagnosed as lung adenocarcinoma at the department of oncology one year ago. Skin biopsy revealed blue nodular lesions in the dermis, composed of clustered heterogeneous tumor cells with glandular formation. Immunohistochemical stains confirmed the diagnosis of metastatic lung adenocarcinoma.
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Abstract
RATIONALE The prognosis of lung cancer is dismal, which has resulted in lung carcinoma being one of the leading causes of cancer-related deaths worldwide. Non-small cell lung cancer accounts for approximately 80% of all types of lung carcinoma. The skeletal system and central nervous system are the most common distal metastatic sites in patients with lung cancer, while cutaneous and soft tissues metastasis is rare. PATIENT CONCERNS We report a case of concomitant metastasis in the nasal tip and suspected buttocks metastasis secondary to lung cancer, who complained of repeated cough and white sputum for 6 months. DIAGNOSE Primary lung cancer was diagnosed by bronchoscopy and biopsy, lesion on nasal tip was confirmed by biopsy. Furthermore, PET-CT scan identified the untouchable buttocks lesion that could have been easily missed. INTERVENTIONS This patient refused systemic treatments, but he chose traditional Chinese medicine at home. OUTCOMES He died 6 months after the diagnosis. LESSONS The possibility of metastasis of primary cancers should be considered when encountering soft-tissue neoplasm lesions, and a biopsy of the suspicious cutaneous lesions could likely aid in the histological identification of the primary cancer. PET-CT scan could be an effective supplementary tool for the diagnosis and evaluation of cancers.
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Affiliation(s)
| | - Jialu Chen
- Department of Gynaecology, Women's & Children's Hospital of Haining city
| | - Fanfan Yang
- Department of Pathology, People's Hospital of Haining city, Haining, Zhejiang province, China
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