In many cases, cutaneous metastasis causes disfigurement and discomfort. See smartphone apps to check your skin. Books about skin diseases Books about the skin Dermatology Made Easy book. DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Cutaneous metastasis — codes and concepts open. Dermal metastasis, Skin secondaries, Metastasis to skin, Malignant infiltration of skin, Secondary cancers of skin, Cancer metastasis to skin.
Clinical presentation of cutaneous metastasis, Common cutaneous metastasis. Advertisement Skin cancer App to facilitate skin self-examination and early detection. References Book: Textbook of Dermatology. Fourth edition. Blackwell Scientific Publications. Sign up to the newsletter.
Full name. Email address. Most common sites of metastasis are the chest and abdomen Less common sites include scalp, neck, upper extremities and back Some patients may develop a firm scar-like area in the skin.
Conclusions and Relevance Dermoscopically visible vascular structures within a cutaneous nodule in patients with a known cancer diagnosis should raise suspicion for cutaneous metastasis. Pigmentation in such lesions, in the absence of a history of melanoma, suggests a primary breast carcinoma. The high prevalence of vascular structures among cutaneous metastases may suggest a role for angiogenesis in their pathogenesis.
These findings support the use of dermoscopy in the evaluation of suspected skin metastases or in the assessment of lesions of unknown origin in patients with cancer. Cutaneous metastases rarely develop in patients having cancer with solid tumors.
The reported incidence of cutaneous metastases from a known primary malignancy ranges from 0. The initial presentation of cutaneous metastases is frequently subtle and may be overlooked without proper index of suspicion, appearing as multiple or single nodules, plaques, and ulcers, in decreasing order of frequency.
Commonly, a painless, mobile, erythematous papule is initially noted, which may enlarge to an inflammatory nodule over time. Clinical features of cutaneous metastases rarely provide information regarding the primary tumor, although the location of the tumor may be helpful because cutaneous metastases typically manifest in the same geographic region as the initial cancer.
The most common primary tumors seen with cutaneous metastases are melanoma, breast, and squamous cell carcinoma of the head and neck. These features may help rule out some nonvascular entities in the differential diagnosis eg, cysts and fibromas.
The presence of pigment most commonly correlates with cutaneous metastases from melanoma. Given the limited body of knowledge regarding distinct clinical findings, we sought to better elucidate the dermoscopic patterns of cutaneous metastases, with the goal of using this diagnostic tool to help identify these lesions.
We describe 20 outpatients with biopsy-proven cutaneous metastases secondary to various underlying primary malignancies. Their clinical presentation is reviewed, emphasizing the dermoscopic findings, as well as the histopathologic correlation. A waiver WA for retrospective review of data was approved by the institutional review board at Memorial Sloan-Kettering Cancer Center. Informed consent was obtained for photography with each biopsy.
Twenty outpatients were selected for whom clinical, dermoscopic, and histologic data were available eTable 1 in the Supplement. The mean age of the patients included was 65 years age range, years. The ratio of women to men was 1. The primary cancers represented include breast 6 cases , colorectal 3 cases , thyroid 2 cases , and ovarian 2 cases ; the remaining were endometrial, gastric, lung, bladder, peritoneal, melanoma, and leiomyosarcoma.
In 15 of 20 patients, the skin lesion was thought to represent a cutaneous metastasis before biopsy. In 4 patients, the differential diagnosis included cutaneous metastasis, and in 1 patient there was no suspicion of cutaneous metastasis. The most common presentation was a new nodule in the anatomical region of the primary cancer 12 of 20 cases , while the additional 8 cases manifested as papules or plaques. Most were erythematous, although 2 cases were predominantly pigmented 1 pink with focal brown pigmentation and 1 flesh-colored.
Five of 20 patients had painful lesions, while 3 other patients reported pruritus. Three lesions were ulcerated at the time of presentation.
The most common dermoscopic finding overall was a vascular pattern, seen in all 17 nonpigmented lesions eTable 2 in the Supplement. In 1 case, arborizing vessels were the only dermoscopic vascular structure seen, originating from the center of the lesion and radiating toward the periphery.
A, Clinically, this vascular pink papule on the nose of a man in his 70s with bladder carcinoma was thought to represent a basal cell carcinoma before biopsy. B, Dermoscopy revealed multiple arborizing and serpentine vessels.
C, Cutaneous metastasis manifesting as a dark pink umbilicated nodule on the face of a man in his 80s with ileocecal carcinoma. D, Dermoscopy revealed arborizing vessels originating in the center of the lesion. E, A woman in her 60s with ovarian cancer and several pink nodules on the thighs, buttocks, and groin. F, Dermoscopy revealed serpentine, comma-shaped, and arborizing vessels, as well as a blue-gray ovoid nest, mimicking basal cell carcinoma.
A, The patient had metastatic melanoma manifesting as pink papules. B, Dermoscopy revealed dotted and serpentine vessels. In 3 cases, hyperpigmentation was noted clinically and correlated with melanocytic patterns on dermoscopic evaluation eTable 3 in the Supplement. All 3 cases represented metastatic breast carcinoma. Brown streaks were observed within all 3 lesions Figure 3 , and blue-gray globules were found in 2 cases. An overlying bluish hue, mimicking a blue-white veil typically found in melanocytic lesions , was seen in one of these cases.
Vascular and melanocytic patterns were present in 1 lesion, with pigmented streaks and dotted vessels. Histopathologic evaluation confirmed the presence of melanocytes and melanophages within the tumor nodules Figure 3 C and D.
A, A woman in her 60s with a deeply pigmented brown nodule, centrally resembling a seborrheic keratosis. B, Dermoscopy revealed brown streaks with peripheral globules and a bluish hue, mimicking a blue-white veil overlying the central lesion.
Focal milky red papillae are also seen. C, Histologic examination showed a dermal mass consistent with adenocarcinoma. D, On high-power magnification, melanophages and melanocytes are seen admixed with the tumor.
E, A woman in her 40s with a firm brown nodule on the chest. F, Dermoscopy revealed central hypopigmentation with a periphery of pigmented streaks and small globules. Cutaneous metastases remain a diagnostic challenge.
Because of the potential implications for prognosis and management, prompt diagnosis of such lesions is crucial. Despite the increase in the use of dermoscopy in recent years, dermoscopic findings in secondary cutaneous malignancy have been largely unreported, perhaps due to the uncommon nature of this entity, as well as a lack of experience with and data on using dermoscopy in this setting.
Metastatic skin lesions deriving from breast cancer are usually asymptomatic measure 1—3 cm, and appear as firm, pink to red-brown nodules on the chest ipsilateral to the primary tumour. Our patient did not have the most common clinical features. First, here CMs were distributed over two body areas, namely the umbilical region, an uncommon site of CMs deriving from breast cancer, and second she presented lesions located contralaterally to the site of the primary tumour.
A skin biopsy is mandatory to diagnose CM. Histological features vary depending on the type of primary malignancy and, in some instances, require differentiation from a primary cutaneous tumour. In the absence of a pertinent clinical history, it can be difficult to ascertain the primary site of metastatic cancers [ 5 ]. However, metastases usually show histopathological similarities to the primary tumour [ 1 ].
Cutaneous metastatic lesions are easily and often misdiagnosed as benign lesions. It is important to recognise them promptly in order to avoid prolonged empirical anti-inflammatory therapy that will delay the correct diagnosis.
Therefore, atypical or persistent nodular lesions in patients with a history of systemic malignancy or suspected malignancy should be considered for biopsy to rule out metastasis [ 5 ]. As for our patient, for more than one year she presented skin lesions that did not arouse any suspicion in her attending physician.
The period between the diagnosis of CM and death has been found to range from 0. Metastases confined to the skin are often indolent, and patients can be maintained with tolerable treatment regimens for a number of years [ 6 ]. Breast cancer metastases to soft tissue typically carry a better prognosis than breast cancer metastases to visceral organs or bone.
Furthermore, CMs from breast cancer do not necessarily have as poor a prognosis as CMs from other internal malignancies. CMs from other internal malignancies carry a 4. A high index of clinical suspicion is essential for diagnosing CM lesions, because the clinical presentation can be subtle and confusing. Although CMs from malignant neoplasms of internal organs are relatively uncommon in clinical practice, it is important to consider this possibility in newly found lesions, however benign they seem.
Early recognition, especially in breast cancer cases, can lead to rapid and accurate diagnosis and timely treatment. Conflicts of Interests: The Authors declare that there are no competing interest. National Center for Biotechnology Information , U. Published online Jan 8. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Oct 30; Accepted Nov 4. This article is licensed under a Commons Attribution Non-Commercial 4. This article has been cited by other articles in PMC. Keywords: Skin lesions, cutaneous metastases, metastatic breast carcinoma, breast cancer. Open in a separate window. Figure 1. Violet erythematous annular plaque in the right inframammary region. Figure 2. Violet erythematous annular plaque in the right anterior axillary region. Figure 3.
Figure 4. Skin with infiltration into the dermis by cords and atypical cells. Footnotes Conflicts of Interests: The Authors declare that there are no competing interest.
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