Cutaneous Metastasis as the First Presentation of Non-Small-Cell Lung Cancer with a BRAF Mutation: A Case Report

[Inaugural Scalp Metastasis of Pulmonary Squamous Cell Carcinoma: A Rare Case Report and Literature Review]

Distant cutaneous metastasis of primary lung squamous cell carcinoma is an exceedingly rare event, with scalp metastasis as the initial clinical presentation even rarer. Scalp skin metastases are prone to be misdiagnosed as other scalp disorders, yet their appearance signifies the deterioration and poor prognosis of lung cancer. This case report documents a female patient presenting initially with scalp folliculitis in dermatology, who was subsequently diagnosed with malignant lung tumor through radiological imaging and referred to Department of Thoracic Surgery. Pathological examination of the excised lesion from the scalp revealed distant metastasis of lung cancer. A review of similar cases reported in literature was conducted. This article aims to enhance understanding and awareness of skin metastasis in lung cancer, to emphasize the importance of this condition, and to improve early recognition and precise diagnosis. It is crucial to prevent clinical misdiagnosis and ensure appropriate treatment, finally leading to improve the prognosis of the patients.
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Cutaneous metastasis as a first presentation of lung carcinoma: a case series

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.

Skin Metastases As First Manifestations of Adenocarcinoma of the Lung: A Case Report

Lung cancer is the second most common malignancy worldwide, accounting for the highest number of cancer deaths. Advanced lung cancer may infrequently appear as skin metastasis and this may be the first sign of the disease. In these cases, survival is low and prognosis is poor. The aim of this study is to report a case of adenocarcinoma of the lung where the earliest manifestations were skin metastases to the face, cervical region, and chest. A 67-year-old male, former smoker, and alcoholic was referred to the oncology center for investigation of a primary tumor site, presenting with skin lesions suggestive of metastasis to the face, cervical region, and chest. Computed tomography (CT) scan of the chest, cholangioresonance, breast ultrasonography, colonoscopy, upper GI endoscopy, and magnetic resonance imaging of the brain were performed. Imaging studies revealed disseminated cancer with a potential primary site in the right lung. Positron emission tomography (PET)-CT scan demonstrated secondary implants and was consistent with primary right lung cancer. The patient underwent a right lung biopsy of the skin and breast and axillary lymph nodes. A solid subtype of adenocarcinoma with metastases to the skin and axillary nodes was confirmed. Due to widespread metastatic disease, the case was conducted using strategies including chemotherapy and palliative radiotherapy for symptomatic control. At about 6 months of follow-up care, the patient died. In the elderly, periodical cancer screening is important, especially in patients with major risk factors (e.g., history of smoking). Some cancers may be virtually silent and manifest themselves only at advanced stages beyond treatment possibilities.

Non-small Cell Lung Cancer With Proto-Oncogene B-Raf V600E Presenting a Distinctive Clinical Course: A Case Report

Cases of proto-oncogene B-Raf (BRAF) V600E mutation are rare, accounting for 1%-4% of non-small cell lung cancers (NSCLCs), and its clinical features remain unclear. Here, we report a case of BRAF mutation-positive lung adenocarcinoma with an atypical clinical course and long-term survival. The patient was a 63-year-old female nonsmoker who was diagnosed with stage IA adenocarcinoma after surgical resection. Five years after the surgery, cancer recurred and was treated with various cytotoxic anticancer agents. During the course of treatment, the patient was found to be BRAF V600E mutation-positive and was treated with molecular-targeted drugs. Although multiple brain, subcutaneous, and tonsillar metastases appeared, the progression was significantly slower, and the patient survived for 14 years and three months after the diagnosis. There have been few case reports of long-term survival in BRAF-positive lung cancer, and more cases need to be accumulated in the future to gather more information. Based on this case, we speculate that sensitivity to cytotoxic anticancer agents such as pemetrexed (PEM) and maintenance of performance status (PS), in addition to molecular-targeted agents, are important for long-term survival.