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Okafor C. Cutaneous Metastasis in Colorectal Cancer: A Rare and Overlooked Phenomenon. Cureus 2024; 16:e53437. [PMID: 38435210 PMCID: PMC10909233 DOI: 10.7759/cureus.53437] [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] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Cutaneous metastasis from internal malignancies, indicative of poor prognosis, is rare and often involves primary sources like lung, breast, and colorectal cancer (CRC). This case details a 66-year-old male developing a scalp lesion 10 years post colon adenocarcinoma diagnosis. The challenging medical journey included a comprehensive biopsy confirming metastatic CRC in cutaneous tissue through CDX2 and CK20 positivity, emphasizing the importance of advanced diagnostic techniques. Despite medical advancements, the patient's unfavorable prognosis led to succumbing within a year, highlighting challenges in managing such cases and the need for vigilant post-diagnosis care. This report underscores the limited understanding of cutaneous metastasis, emphasizing the role of immunostaining and prompting awareness for early detection and tailored treatment. Further research into atypical metastasis mechanisms is crucial for improved prognostic outcomes and enhanced comprehension of these complex manifestations.
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Affiliation(s)
- Chinedum Okafor
- Pathology, Louisiana State University Health System, Shreveport, USA
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2
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Loo JH, Ng IAT, Chia CS, Wong SK. Caecal adenocarcinoma presenting as vulvar Paget's disease. ANZ J Surg 2021; 92:2331-2333. [PMID: 34970827 DOI: 10.1111/ans.17444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/25/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jing Hong Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Irene Ai Ting Ng
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Soong Kuan Wong
- The Colorectal Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore
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3
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Koch K, Grayson W. Carcinoid Syndrome-Induced Scleroderma-Like Disease. Dermatopathology (Basel) 2019; 6:99-104. [PMID: 31700850 PMCID: PMC6827453 DOI: 10.1159/000496388] [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: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022] Open
Abstract
Scleroderma is a rare complication of carcinoid syndrome and is usually encountered in the setting of a metastatic primary neuroendocrine tumour of the distal ileum. Associated endocardial fibrosis is a frequent finding and the condition carries a poor prognosis. We report a case of scleroderma occurring in a 72-year-old female with metastatic neuroendocrine carcinoma and associated pericardial fibrosis. The use of an alternative nomenclature such as “scleroderma-like” or “sclerodermoid” disease is proposed in order to emphasise its distinction from true idiopathic scleroderma, despite the histopathological similarities on skin biopsy.
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Affiliation(s)
- Karen Koch
- Dermatology Department, Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Wayne Grayson
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Ampath National Laboratories, Johannesburg, South Africa
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4
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Rao AG, Farheen SS, Amit K, Reddy UD, Aparna K, Kranthi J, Hukkani R. Erythema Gyratum Repens Associated With Diffuse B-cell Lymphoma-Report of A Rare Case. Indian J Dermatol 2019; 64:338. [PMID: 31516154 PMCID: PMC6714186 DOI: 10.4103/ijd.ijd_228_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Erythema gyratum repens (EGR) is a rare paraneoplastic dermatosis known to be associated with internal malignancy. Herein, we report a case of EGR with diffuse large B-cell lymphoma (DLBCL) in a young farmer who presented with generalized massive lymphadenopathy and wood-grain pattern dermatosis. Lymph node biopsy with immunohistochemistry established the diagnosis of DLBCL. He was managed by the oncologist with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen which alleviated his symptoms considerably after completion of three cycles and was under follow-up.
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Affiliation(s)
| | - Syeda Saba Farheen
- Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
| | - Kolli Amit
- Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
| | - Uday Deshmukh Reddy
- Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
| | - Karanam Aparna
- Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
| | | | - Ruhi Hukkani
- Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
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5
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McClatchey TM, Haynes D, Korcheva VB, Keller J. Acrokeratosis paraneoplastica (Bazex syndrome) associated with peripheral T-cell lymphoma. JAAD Case Rep 2018; 5:86-88. [PMID: 30581941 PMCID: PMC6297902 DOI: 10.1016/j.jdcr.2018.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Veselina B Korcheva
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Jesse Keller
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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6
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Erythroderma and Figurate Erythemas. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Caccavale S, Brancaccio G, Agozzino M, Vitiello P, Alfano R, Argenziano G. Obligate and facultative paraneoplastic dermatoses: an overview. Dermatol Pract Concept 2018; 8:191-197. [PMID: 30116663 PMCID: PMC6092071 DOI: 10.5826/dpc.0803a09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Dermatological paraneoplastic syndromes are a group of cutaneous diseases associated with malignancy, but not directly related to the primary tumor itself or to its metastases. It is of utmost importance for the dermatologist to recognize the major cutaneous paraneoplastic syndromes to diagnose the underlying tumors that trigger them as early as possible. In this overview, skin conditions that are highly correlated with malignancy, whose recognition implies a mandatory investigation of internal cancer, are described.
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Affiliation(s)
- Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Marina Agozzino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Vitiello
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, Italy
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8
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Dumont S, Péchère M, Toutous Trellu L. Chronic Prurigo: An Unusual Presentation of Hodgkin Lymphoma. Case Rep Dermatol 2018; 10:122-126. [PMID: 29928200 PMCID: PMC6006658 DOI: 10.1159/000489161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background Prurigo nodularis is a condition of unknown origin defined by papulonodular eruption and intense pruritus. Hodgkin lymphoma often presents nonspecific initial symptoms. An association between systemic malignancy and cutaneous manifestations has long been documented. We report a case of prurigo nodularis as a first presentation of Hodgkin lymphoma. Case A 35-year-old woman presented with a 2-year history of pruritus. Previously diagnosed with bedbugs, the pruritus persisted even after insect eradication, with the appearance of papulonodular lesions consistent with chronic prurigo. The pruritus and the pain were refractory to all treatments. She had no past medical history or clinical, radiological, or laboratory findings. A lymphadenopathy was revealed 2 years after onset of the symptoms. Lymph node biopsy showed a nodular sclerosis Hodgkin lymphoma. The patient was initiated on chemotherapy and the skin lesions decreased. Conclusion This case report of chronic prurigo as the first manifestation of a systemic malignancy reminds us of the importance of a systematic diagnostic approach to this kind of patients initially and throughout time, especially if the symptoms do not respond to treatment. Our case may question the role of imaging examinations in the management and follow-up of a persistent prurigo nodularis.
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Affiliation(s)
- Shireen Dumont
- Internal Medicine Department, Hôpital de la Tour, Geneva, Switzerland
| | - Marc Péchère
- Department of Dermatology, Geneva University Hospital, Geneva, Switzerland
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9
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Pruritus: Progress toward Pathogenesis and Treatment. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9625936. [PMID: 29850592 PMCID: PMC5925168 DOI: 10.1155/2018/9625936] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/15/2018] [Accepted: 02/11/2018] [Indexed: 02/06/2023]
Abstract
Pruritus, the most common cutaneous symptom, is widely seen in many skin complaints. It is an uncomfortable feeling on the skin and sometimes impairs patients' quality of life. At present, the specific mechanism of pruritus still remains unclear. Antihistamines, which are usually used to relieve pruritus, ineffectively work in some patients with itching. Recent evidence has suggested that, apart from histamine, many mediators and signaling pathways are involved in the pathogenesis of pruritus. Various therapeutic options for itching correspondingly have been developed. In this review, we summarize the updated pathogenesis and therapeutic strategies for pruritus.
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10
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Kemal Y, Odabaşı EA, Kemal Ö, Bakırtaş M. Cutaneous metastasis of colon adenocarcinoma. Turk J Surg 2018; 34:237-239. [PMID: 30302429 DOI: 10.5152/turkjsurg.2017.3298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/31/2015] [Indexed: 11/22/2022]
Abstract
Skin metastasis originating from colorectal cancer is a rare entity and usually signifies poor prognosis. We present a case of a 62-year-old male patient who presented with a cutaneous metastatic focus on his forehead after five years of the primary treatment of colon cancer. Complete response from the cutaneous metastasis nodule was achieved with radiotherapy. The patient is still alive and under a second-line palliative chemotherapy regimen because of the multiple liver metastases. It is important for physicians to be aware of skin metastasis in patients with an oncology history.
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Affiliation(s)
- Yasemin Kemal
- Department of Medical Oncology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Eylem Aliş Odabaşı
- Department of Radiation Oncology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Özgür Kemal
- Department of Otorhinolaryngology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Mustafa Bakırtaş
- Department of Pathology, Samsun Training and Research Hospital, Samsun, Turkey
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11
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Sadeghian A, Rouhana H, Oswald-Stumpf B, Boh E. Etiologies and management of cutaneous flushing. J Am Acad Dermatol 2017; 77:405-414. [DOI: 10.1016/j.jaad.2016.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/07/2016] [Accepted: 12/18/2016] [Indexed: 12/31/2022]
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12
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Abstract
The burden of chronic pruritus is increasingly recognized as significant worldwide. As wet-laboratory researchers investigate the pathophysiology of chronic pruritus, epidemiologists and health services researchers are quantifying the impact of pruritus by incidence, prevalence, and quality of life measures. Outcomes researchers are also investigating factors that may predict chronic pruritus incidence and severity. Such efforts will direct resources for research, public health intervention, and clinical care.
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13
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Rubegni P, Feci L, Fimiani M. Three simultaneous paraneoplastic skin manifestations in a patient with renal angiosarcoma. Clin Exp Dermatol 2014; 39:553-4. [PMID: 24707931 DOI: 10.1111/ced.12298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- P Rubegni
- Dermatology Section, Department of Clinical Medicine and Immunology, University of Siena, Siena, Italy
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14
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Schweda K, Hainz M, Loquai C, Grabbe S, Saloga J, Tuettenberg A. Prurigo nodularis as index symptom of (non-Hodgkin) lymphoma: ultrasound as a helpful diagnostic tool in dermatological disorders of unknown origin. Int J Dermatol 2014; 54:462-4. [DOI: 10.1111/ijd.12022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kathrin Schweda
- Departments of Dermatology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Michael Hainz
- Departments of Pathology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Carmen Loquai
- Departments of Dermatology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Stephan Grabbe
- Departments of Dermatology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Joachim Saloga
- Departments of Dermatology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Andrea Tuettenberg
- Departments of Dermatology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
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15
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Yuste Chaves M, Unamuno Pérez P. Alertas cutáneas en malignidades sistémicas (parte 2). ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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16
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Yuste Chaves M, Unamuno Pérez P. Cutaneous manifestations of systemic malignancies: part 2. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:543-53. [PMID: 23891448 DOI: 10.1016/j.adengl.2012.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 12/12/2022] Open
Abstract
The skin can be key to early diagnosis of systemic malignancies. In the second part of this review, we present various skin conditions that can, in certain contexts, reveal the presence of malignancy. The skin conditions are presented in groups based on a diverse range of morphological characteristics. Specifically, the following groups are analyzed: erosive and blistering lesions; inflammatory papules and nodules; xerosis, ichthyosis, and generalized exfoliative dermatitis; symptoms such as pruritus; abnormal hair distribution patterns; sweating disorders; benign tumors that can form part of hereditary syndromes associated with a risk of visceral cancer; and finally, oral and nail abnormalities. This review highlights the importance of the skin in the study of systemic malignancies.
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Affiliation(s)
- M Yuste Chaves
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain.
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17
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Yuste-Chaves M, Unamuno-Pérez P. Alertas cutáneas en malignidades sistémicas (parte I). ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Yuste-Chaves M, Unamuno-Pérez P. Cutaneous alerts in systemic malignancy: part I. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:285-98. [PMID: 23578547 DOI: 10.1016/j.adengl.2012.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 03/13/2012] [Indexed: 12/16/2022] Open
Abstract
The aim of this review is to familiarize dermatologists and clinicians in general with cutaneous signs and symptoms that can help lead to an early diagnosis of an underlying malignancy. Because the skin is one of the most accessible organs, it should never be overlooked in systemic disease. Examination of the skin has the advantage of revealing important information about the patient's condition without requiring the use of invasive techniques. In the literature, most discussions of cutaneous manifestations of internal malignancy refer to classic paraneoplastic syndromes, but a wide variety of skin conditions, while not strictly paraneoplastic, can, in certain contexts, indicate the presence of malignancy or an increased risk of developing cancer later in life. In this review, various skin conditions that can signal malignancy or increased cancer risk are presented in randomly ordered groups based on clinical morphology. Conditions with multiple signs and symptoms have been classified on the basis of their most characteristic feature.
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Affiliation(s)
- M Yuste-Chaves
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain.
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El Khoury J, Khalifeh I, Kibbi AG, Abbas O. Cutaneous metastasis: clinicopathological study of 72 patients from a tertiary care center in Lebanon. Int J Dermatol 2013; 53:147-58. [PMID: 23557182 DOI: 10.1111/j.1365-4632.2012.05650.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. OBJECTIVE To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut - Medical Center (AUB-MC) and to compare our findings with those published in the literature. METHODS Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB-MC between 1992 and 2010. RESULTS A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). CONCLUSION This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences.
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Affiliation(s)
- Jinane El Khoury
- Departments of DermatologyPathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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20
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Shah KR, Boland CR, Patel M, Thrash B, Menter A. Cutaneous manifestations of gastrointestinal disease. J Am Acad Dermatol 2013; 68:189.e1-21; quiz 210. [DOI: 10.1016/j.jaad.2012.10.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 01/13/2023]
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21
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Gore M, Winters ME. Erythema gyratum repens: a rare paraneoplastic rash. West J Emerg Med 2012; 12:556-8. [PMID: 22224159 PMCID: PMC3236141 DOI: 10.5811/westjem.2010.11.2090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 10/28/2010] [Accepted: 11/01/2010] [Indexed: 12/02/2022] Open
Abstract
Erythema gyratum repens (EGR) is a rare and characteristic, paraneoplastic rash associated with a variety of malignancies, most notably lung, esophageal, and breast cancers. This case report details the appearance, epidemiology, diagnosis, and treatment of EGR. Prompt identification of EGR is essential, as the rash often precedes the diagnosis of malignancy by several months. Urgent patient referral to evaluate for malignancy is crucial, as this may lead to decreased morbidity and mortality.
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Affiliation(s)
- Marina Gore
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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22
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Chang AK, Lotterman CD, Steele R. Itching in a teenager. Clin Pediatr (Phila) 2011; 50:672-4. [PMID: 21345878 DOI: 10.1177/0009922810384851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alicia K Chang
- Tulane University School of Medicine, New Orleans, LA, USA.
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23
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De Giorgi V, Grazzini M, Alfaioli B, Savarese I, Corciova SA, Guerriero G, Lotti T. Cutaneous manifestations of breast carcinoma. Dermatol Ther 2011; 23:581-9. [PMID: 21054704 DOI: 10.1111/j.1529-8019.2010.01365.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The incidence of breast carcinoma cutaneous manifestation in patients with breast carcinoma is 23.9%. The most common sites of breast carcinoma cutaneous manifestation are the chest wall and abdomen, but they can occur at the extremities and in the head/neck region. Due the high incidence of breast carcinoma, these cutaneous manifestations are the most common metastases seen by dermatologists. In clinical practice, cutaneous metastases show a wide range of clinical manifestations. Nodules are the most common presentation, but several other patterns are described below.
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24
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Nashan D, Meiss F, Braun-Falco M, Reichenberger S. Cutaneous metastases from internal malignancies. Dermatol Ther 2011; 23:567-80. [PMID: 21054703 DOI: 10.1111/j.1529-8019.2010.01364.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cutaneous metastases of internal malignancies still seem to occur infrequently, although medical publications report an incidence rate of up to 10.4%. Common sense, however, fosters suspicion that we might underdiagnose the problem distracted by harder striking facets of an advanced disease. With contemporary knowledge, morphology and behavior of cutaneous metastases resemble each other regardless of the site of origin. This article itemizes clinical presentations according to organ systems, specific features, and differential diagnoses. In general, the survival turned out to be less than 12 months. But incremental awareness of cutaneous metastases proclaims this paradigm insufficient. Although excision is the local treatment of choice, investigations attempt to propose tumor-specific chemotherapeutic/immunological approaches. This paper endeavors to critically review the state of the art concerning the clinic, prognosis, and therapeutic concepts.
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Affiliation(s)
- Dorothée Nashan
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
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25
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Cassano N, Tessari G, Vena GA, Girolomoni G. Chronic pruritus in the absence of specific skin disease: an update on pathophysiology, diagnosis, and therapy. Am J Clin Dermatol 2010; 11:399-411. [PMID: 20866115 DOI: 10.2165/11317620-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic pruritus is a major and distressing symptom of many cutaneous and systemic diseases and can significantly impair the patient's quality of life. Pruritus perception is the final result of a complex network involving dedicated nerve pathways and brain areas, and an increasing number of peripheral and central mediators are thought to be involved. Itch is associated with most cutaneous disorders and, in these circumstances, its management overlaps with that of the skin disease. Itch can also occur without associated skin diseases or primary skin lesions, but only with nonspecific lesions secondary to rubbing or scratching. Chronic itch with no or minimal skin changes can be secondary to important diseases, such as neurologic disorders, chronic renal failure, cholestasis, systemic infections, malignancies, and endocrine disorders, and may also result from exposure to some drugs. The search for the cause of pruritus usually requires a meticulous step-by-step assessment involving careful history taking as well as clinical examination and laboratory investigations. Few evidence-based treatments for pruritus are available. Topical therapy, oral histamine H(1) receptor antagonists, and phototherapy with UV radiation can target pruritus elicitation in the skin, whereas antiepileptic drugs, opioid receptor antagonists, and antidepressants can block signal processing in the CNS.
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Affiliation(s)
- Nicoletta Cassano
- Second Dermatology Clinic, MIDIM Department, University of Bari, Bari, Italy
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Liu B, Huang XQ, Wang J, Dong JH, Huang ZQ. Hepatobiliary malignancies with cutaneous metastases: an analysis of 8 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:2166-2170. [DOI: 10.11569/wcjd.v18.i20.2166] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinical characteristics and therapeutic outcomes of 8 cases of hepatobiliary malignancies with cutaneous metastases.
METHODS: From June 2006 to June 2009, eight patients with cutaneous metastases from hepatobiliary malignancies were treated at our hospital. By retrospectively reviewing the clinical data for these patients, the clinical characteristics, treatment and prognosis of this disease were summarized.
RESULTS: One patient with hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by bile duct tumor thrombi developed cutaneous metastasis at the port site 20 mo after percutaneous transhepatic biliary drainage (PTBD). The patient had survived 16 mo after resection of the port-site tumor and showed no recurrence. One HCC patient developed tumor at the incision site 9 mo after abdominal exploration. After the skin and liver tumors were excised, the patients survived 8 mo. One patient with combined HCC and cholangiocellular carcinoma developed multiple cutaneous metastases of cholangiocellular carcinoma and survived 8 mo. Two patients with cholangiocarcinoma and solitary nodular cutaneous metastasis received skin tumor excision and survived 8 and 10 mo, respectively. Of three patients with cholangiocarcinoma and multiple cutaneous metastases, one received chemotherapy and survived 6 mo, and the other 2 refused any treatment and survived 3 and 4 mo, respectively.
CONCLUSION: Puncture and operation procedures should be improved to avoid seeding metastasis. In patients with hepatobiliary malignancies, solitary nodular cutaneous metastasis has a better prognosis, while multiple cutaneous metastases have a worse prognosis.
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Ehst BD, Minzer-Conzetti K, Swerdlin A, Devere TS. Cutaneous manifestations of internal malignancy. Curr Probl Surg 2010; 47:384-445. [PMID: 20363406 DOI: 10.1067/j.cpsurg.2010.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Shinjo T, Okada M. Palmar Petechiae (Black Spots on Palms) in Terminally Ill Patients with Cancer: A Sign of Impending Death. J Palliat Med 2010; 13:615-8. [DOI: 10.1089/jpm.2009.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takuya Shinjo
- Palliative Care Unit, Shakaihoken Kobe Central Hospital, Kobe, Japan
| | - Masakuni Okada
- Palliative Care Unit, Shakaihoken Kobe Central Hospital, Kobe, Japan
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Ivan D, Prieto VG. Histopathology of inflammatory skin disease in oncological patients. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mpdhp.2009.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Accorsi-Neto A, Haidar M, Simões R, Simões M, Soares-Jr J, Baracat E. Effects of isoflavones on the skin of postmenopausal women: a pilot study. Clinics (Sao Paulo) 2009; 64:505-10. [PMID: 19578653 PMCID: PMC2705153 DOI: 10.1590/s1807-59322009000600004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Accepted: 03/02/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of isoflavones on the skin of postmenopausal women. DESIGN A prospective study was performed with 30 postmenopausal women before and immediately after the end of treatment with 100 mg/day of an isoflavones-rich, concentrated soy extract for six months. A skin punch was performed in the gluteal region for sample collection before and immediately after the treatment program. Morphometric determination of epidermal thickness, the papillary index (wrinkling), and the amount of dermal elastic and collagen fibers was assessed. In addition, the number of blood vessels in the sample was also evaluated. The paired Student's t-test was used for statistical analysis (P < 0.05). RESULTS Isoflavone treatment resulted in a 9.46% increase in the thickness of the epidermis in 23 patients. In addition, the papillary index was reduced in 21 women. The papillary index was inversely proportional to skin wrinkling, i.e., there were a large number of papillae after treatment. The amount of collagen in the dermis was increased in 25 women (86.2%). In 22 women (75.8%) we observed that the number of elastic fibers increased. The number of dermal blood vessels was significantly increased in 21 women. CONCLUSION Our data show that the use of a concentrated, isoflavone-rich soy extract during six consecutive months caused significant increases in epithelial thickness, the number of elastic and collagen fibers, as well as the blood vessels.
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Affiliation(s)
- Alfeu Accorsi-Neto
- Gynecology Department, Federal University of São Paulo (UNIFESP) - São Paulo/SP, Brazil
| | - Mauro Haidar
- Gynecology Department, Federal University of São Paulo (UNIFESP) - São Paulo/SP, Brazil
| | - Ricardo Simões
- Gynecology Department, Federal University of São Paulo (UNIFESP) - São Paulo/SP, Brazil
| | - Manuel Simões
- Morphology Department, Federal University of São Paulo (UNIFESP) - São Paulo/SP, Brazil
| | - José Soares-Jr
- Gynecology Department, Federal University of São Paulo (UNIFESP) - São Paulo/SP, Brazil
- LIM-58, Laboratório de Ginecologia Estrutural e Molecular, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
- , Tel: 55 11 5081-3685
| | - Edmund Baracat
- LIM-58, Laboratório de Ginecologia Estrutural e Molecular, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP,Brazil. Study performed at: Gynecology Department of the Federal University of São Paulo (UNIFESP) - São Paulo/SP, Brazil
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31
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[Skin signs of systemic diseases]. Internist (Berl) 2008; 50:137-49. [PMID: 19096815 DOI: 10.1007/s00108-008-2206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many aspects of cutaneous signs are of importance to nondermatologists, as skin manifestations can reflect internal disease states, either directly or as a result of a complication or treatment and therefore can lead to the diagnosis of systemic illness. Serious morbidity and mortality can be avoided by early recognition of only minor cutaneous manifestations signaling internal problems. Limited forms of collagen vascular disease exemplify the important marker function of the skin for diagnosis as well as for prognosis with their typically favorable course permitting a less aggressive treatment. The utmost important prerequisite of diagnosing skin conditions is an accurate and thorough examination of the skin, the adjacent mucous membranes and the integumentary appendages. In a first step, the primary site of the cutaneous condition should be identified (e.g. epidermal, dermal or subdermal) and then the form, the pattern, and distribution should be recognized. There are many comprehensive and excellent textbooks available for guidance. This article focuses on the more common dermatologic conditions linked to different organ systems involved (excluding infectious diseases, metabolic diseases and drug induced conditions).
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Cutaneous metastases of visceral tumours: a review. J Cancer Res Clin Oncol 2008; 135:1-14. [PMID: 18560891 DOI: 10.1007/s00432-008-0432-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 05/26/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 10% of all visceral malignancies develop cutaneous metastases. As cutaneous metastases are underestimated and underdiagnosed they can be a clinical challenge. The clinical appearance and patterns of distribution of cutaneous metastases, the characterisation of clinical outcomes and available therapeutic options are compiled. PATIENTS AND METHODS Literature (over the last 6 years) MESH in terms of cutaneous metastases was comprehensively evaluated. Characteristics from 92 available cases are elaborated and adjusted with terms (time unlimited) of published epidemiological reviews to single organs. RESULTS The broad clinical spectrum with differential diagnoses is displayed. An allocation of cutaneous metastases and a particular organ is not reliable. In 22% of all cases cutaneous metastases can lead to the diagnosis of an internal malignoma. The majority of cases reveal cutaneous metastases to emerge in a tumour-free interval in about 36 months, after a successful treatment of the primary tumour, most commonly along with other organ metastases. Probable survival turned out to be less than 12 months. Consistently with this end-stage condition, treatment aligns with rules of palliation. Local treatment of choice is excision. Only a minority of investigators attempted to come up with tumour-specific treatment strategies, and almost no randomised therapy studies can be presented. CONCLUSION A reference guide of cutaneous metastases is given; the clinical spectrum is adjusted to an actual status; state of the art of the treatment is accomplished. An epidemiological, improved registration and diagnostic work-up for targeted therapies in conjunction with dermatologists are favoured.
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Woo VL, Abdelsayed R. Oral manifestations of internal malignancy and paraneoplastic syndromes. Dent Clin North Am 2008; 52:203-x. [PMID: 18154871 DOI: 10.1016/j.cden.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Malignant tumors of visceral organs are a fundamental feature of familial cancer and paraneoplastic syndromes. In many instances, the presence of an internal and often occult malignancy may be forewarned by various external manifestations. Several of these findings are preferentially localized to the head and neck region, including the oral cavity proper. This places the dental practitioner in a unique position to detect these "markers" of occult neoplastic involvement. Because these markers may present before an established syndrome or cancer diagnosis, even representing the first expression of disease in some cases, early recognition by a dentist may lead to timely diagnosis and management of these cancer-associated syndromes.
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Affiliation(s)
- Victoria L Woo
- Columbia University College of Dental Medicine, 630 West 168th Street, PH 1562 West, New York, NY 10032, USA.
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