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Cassalia F, Bolzon A, Ponzano M, Ventura L, Danese A, Del Fiore P, Belloni Fortina A, Jovine E, Perri G, Cillo U, Marchegiani G. The Importance of Reading the Skin: Cutaneous Metastases of Pancreatic Cancer, a Systematic Review. J Clin Med 2023; 13:104. [PMID: 38202111 PMCID: PMC10779471 DOI: 10.3390/jcm13010104] [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: 11/18/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pancreatic cancer is notorious for its aggressive nature and low survival rate, with less than 10% of patients surviving beyond five years. Early detection is difficult, but skin metastases can be a rare but significant indicator. This systematic review focuses on the epidemiology, clinical features, and histology of skin metastases from pancreatic cancer to determine their importance in early diagnosis and overall management of the disease. MATERIALS AND METHODS Following PRISMA guidelines, we conducted an exhaustive search of MEDLINE/PubMed, EMBASE, and SCOPUS databases up to June 2023, using specific keywords. Four independent investigators screened the studies using predefined criteria, and two investigators checked the accuracy and consistency of the data extraction. We assessed the quality of the trials using adapted criteria from the Joanna Briggs Institute. A narrative synthesis rather than a meta-analysis was chosen because of the different study designs. RESULTS The final analysis included 57 patients with skin metastases from pancreatic cancer. Cutaneous metastases, although rare, presented with approximately equal gender distribution and a mean age of 63.4 years. Predominantly non-umbilical (77%), these metastases showed clinical diversity, ranging from asymptomatic nodules to painful or ulcerated lesions. Notably, skin metastases often preceded the diagnosis of primary pancreatic cancer (58%). Primary tumor characteristics revealed different localizations, with adenocarcinoma being the most prevalent histological type (77%). A significant association (p = 0.008) was observed between pancreatic tumor location and the timing of presentation of skin metastases. Tumors located in the body and tail of the pancreas were more likely to manifest skin metastases as an initial clinical manifestation (62.2%) than those in the head of the pancreas (20.8%). CONCLUSIONS In conclusion, although skin metastases are rare, they are important indicators of pancreatic cancer, highlighting the need for multidisciplinary healthcare collaboration and thorough skin examination. Recognizing them could lead to earlier diagnosis, which is crucial in a cancer with limited treatment options.
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Affiliation(s)
- Fortunato Cassalia
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
| | - Anna Bolzon
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
| | - Monica Ponzano
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
| | - Laura Ventura
- Department of Statistics, University of Padua, 35121 Padova, Italy;
| | - Andrea Danese
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
- Department of Woman’s and Children’s Health, University of Padua, 35121 Padua, Italy
| | - Elio Jovine
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, 40133 Bologna, Italy;
| | - Giampaolo Perri
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, 40133 Bologna, Italy;
- Hepatopancreatobiliary and Liver Surgery, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35121 Padua, Italy; (G.P.); (U.C.)
| | - Umberto Cillo
- Hepatopancreatobiliary and Liver Surgery, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35121 Padua, Italy; (G.P.); (U.C.)
| | - Giovanni Marchegiani
- Hepatopancreatobiliary and Liver Surgery, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35121 Padua, Italy; (G.P.); (U.C.)
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