A Case of Cutaneous Metastases to the Face and Scalp from Colon Adenocarcinoma / 대한피부과학회지

Cutaneous metastases occur uncommonly with a reported incidence of 0.7% to 10% in all patients with internal organ malignancy. Cutaneous metastases in the face occur in less than 0.5% of patients with metastatic skin cancer. Cutaneous metastases occur in less than 4% of colon adenocarcinoma patients and the most frequent site is the abdominal skin, especially the scar of previous surgical incision. But metastases to the skin of the head and neck region from colon adenocarcinoma are rare and especially, facial skin metastases are very rare. We report a case of cutaneous metastasis to the face and scalp from colon adenocarcinoma.

Clinicopathological Study on Metastatic Skin Cancer / 대한피부과학회지

BACKGROUND: Metastatic skin cancers are relatively uncommon, however, may forcast the diagnosis of internal malignancy. Therefore, early recognition can contribute to proper management. OBJECTIVE: We studied patients with metastatic skin cancer to find out average age, gender distribution, frequency of primary tumor, time interval between manifestation and primary cancer, and their clinical appearance, location, other metastatic sites and survival time. METHODS: We reviewed the medical records, clinical photographs and histopathologic records of 80 patients who had been diagnosed with metastatic skin cancer at the department of dermatology and pathology in Chonbuk National University Hospital during the last 19 years from January 1986 to December 2004. RESULTS: The mean age at the time of diagnosis was 58.8 years. The ratio of men to women was 1.05:1. The most frequent primary tumors were breast cancer (20.0%), lung cancer (15.0%), colorectal cancer (8.8%), head and neck cancer (8.8%), and gastric cancer (8.8%). Lung cancer in men and breast cancer in women were the most common primary cancers. The sites of metastatic skin cancer were widespread over the whole body. However, the abdomen and chest were the most common sites for metastases, because most cutaneous metastases occur at body regions near the primary tumor. Metastatic skin cancers usually presented as discrete, painless, hard nodules, with sudden onset. However, we also found ulcers, inflammatory patches, plaques and cystic masses as clinical manifestations of metastatic skin cancer. The mean interval time between manifestation and primary tumor was 23.5 months. Histopathological findings indicated that adenocarcinoma was the most common pathologic type, followed by squamous carcinoma, melanoma and small cell carcinoma. Metastatic skin cancers revealed grave prognosis. The mean survival time after diagnosis of metastatic skin cancer was 9.9 months. CONCLUSION: The incidence of metastatic skin cancer was much lower than in western countries, maybe because of genetic and racial differences. Overall incidence of common metastatic skin cancer was similar to that found in the literature, but our results showed a periodic difference according to primary cancer type, other organs metastasized, plus mean survival rate was 9.9 months, thereby confirming a poor prognosis of metastatic skin cancer.

Clinicopathologic Findings of Metastatic Skin Cancer / 대한피부과학회지

BACKGROUND: The incidence of metastatic skin cancer has been reported to be relatively low. Because the diagnosis is not so difficult, cutaneous metastasis could be an important clue to discover the hidden internal malignancy, if found before recognizing primary cancer, or play a significant role to determine therapeutical plans and prognosis if found after diagnosis of primary cancer. MATERIAL AMD METHODS: This study was made upon the 68 cases of metastatic skin cancer, which had been confirmed histopathologically in the department of dermatology, Kosin University Gospel hospital from January, 1986 to August, 2003. Age and sex distributions, sites of primary cancer, time of detection, localization of the lesions, morphologic and histopathologic findings were examined by the review of medical records, clinical photographs, and pathologic slides. RESULTS: 1. The mean age at the time of diagnosis was 56.6 years and most patients were distributed over 5 decades. The male to female ratio was 1: 1.3. 2. Metastasis from breast carcinoma consisted of 19 cases, this was the most common primary cancer, followed by lung cancer, melanoma, and stomach cancer. In men, lung cancer and stomach cancer were the most common primary neoplasm, while breast cancer was the most frequent in women. 3. 50 of the cases were detected after diagnosis of primary cancer and during therapy. The other 18 cases were detected before the internal malignancy was recognized. 4. The localization of metastatic skin cancer was widespread over the whole body. The majority of cutaneous metastasis was predisposed to the surface near primary cancer, but distant metastases such as alopecia neoplastica on the scalp were also observed. 5. The most common morphologic features were single or multiple nodules, while inflammatory and indurated plaques were also found. 6. Histopathologic examination revealed that adenocarcinoma was the most common pathologic type, followed by squamous cell carcinoma and melanoma. The histopathologic features of cutaneous metastasis generally mimicked that of primary tumors. CONCLUSION: Generally, metastatic skin cancer is detected after the diagnosis of primary cancer showing subsequent treatment failure and poor prognosis. In some cases, however, cutaneous metastasis can be the earliest sign to recognize internal malignancy. Especially in the cases of metastatic skin cancer originating from the kidney, liver and thyroid gland, cutaneous features are the most significant evidences to presume the site of origin without any other findings. Therefore, it is important to recognize the clinical and histopathologic findings of metastatic skin cancer for the most successful diagnostic, therapeutic and prognostic determination.

A Case of Carcinoma en Cuirasse from Thyroid Cancer / 대한피부과학회지

A 52-year-old male had presented with painful swelling on the left shoulder. The lesion had progressed to involve the left chest, neck, and arm, and 3 months later, evolved into brown to light purplish hard plaque mimicking the feature of scleroderma. A skin biopsy findings were consistent with metastatic carcinoma, and neck MRI and thyroid sonogram revealed primary thyroid cancer of left lobe. The patient's condition was carcinoma en cuirasse, an uncommon clinical feature of metastatic skin cancer. Skin metastasis of thyroid cancer is rare, and to our knowledge, there is not any documented case of carcinoma en cuirasse from thyroid cancer. We present a case of carcinoma en cuirasse from thyroid cancer.

Clinicopathological Study of 43 Cases of Metastatic Skin Cancer / 대한피부과학회지

BACKGROUND: Carcinoma metastatic to the skin is a rare occurrence and there were few reports about the characteristics of metastatic skin cancer in Korea. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathological characteristics of metastatic skin cancer in our hospital. METHODS: A clinical and histopathological observation was made analysing 43 cases of metastatic skin cancer diagnosed at the Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine during the last 7 years from 1995 to 2001. RESULTS AND CONCLUSION: The results were as follows; 1. The ratio of men to women was 1 : 1.3, and the mean age was 54.4 years. 2. In men, the most common primary tumor was lung cancer, followed by stomach cancer and esophageal cancer. In women, the most common one was breast cancer, followed by stomach cancer. It was an uncommon finding that cutaneous metastases of esophageal cancer showed high incidence (9.3%). 3. Histolopathologic examination revealed that adenocarcinoma(65%) was the most common histologic type, and the second was squamous cell carcinoma(23%). 4. In cases of breast and stomach cancer, cutaneous metastases were found near the primary tumor.

Metastatic Cancer of the Skin: Clinical and histopathologic study / 대한피부과학회지

BACKGROUND: Metastatic skin cancer may have profound diagnostic, therapeutic, and prognostic significance. OBJECTIVE: We studied patients with metastatic skin cancer to determine the relative frequencies of metastatic skin cancer according to the type and location of the primary tumor and the site of the cutaneous metastasis. METHODS: We reviewed medical records and histologic materials of 68 patients with metastatic skin cancer in Catholic University Hospital from January 1991 to March 2001. RESULTS AND CONCLUSIONS:Of 61,218 patients with internal malignancy, 68(0.11%) had metastatic skin cancer. The mean age at diagnosis was 64.7 in male and 58.2 in female. Male to female ratio was 1:2.2. Breast carcinoma was by far the most common primary neoplasm resulting in skin involvement and accounted for 31(45.6%) of total cases and 63.8% of the cases in women. The most common clinical presentation is a nodule(26.5%) or multiple nodules(64.7%) although carcinoma erysipelatoides(4.4%) and carcinoma en cuirasse(4.4%) were also seen. Histopathologic examination most frequently revealed adenocarcinoma(70.6%) that was sometimes suggestive of the site of origin.

Immunohistochemical Staining in Metastatic Skin Cancer / 대한피부과학회지

Immunohistochemial staining was performed in metastatic skin cancer using a variety of antistera. Both carcinoembrytonic antigen(CEA) and epithelial membrane antigen(EMA) were demonstrated in large cell carcinoma of the lung, adenocarcinoma of the stomach and skin adnexal cancer with eccrine differentiation. Although papillary carcinoma of the thyroid, squamous cell carcinoma of the skin and squamous cell carcinoma of the lung showed positive staining for CEA and EMA, these were weak or focal reactions in the keratinizing area. In rectal adenocarcinoma, staining for CEA was significantly positive, but staining for EMA was negative. Epiderrnal cytokeratin was observed in squamous cell carcinoma of the lung, squamous cell carcinoma of the skin and skin adnexal cancer with eccrine differentiation. Epidermal cytokeratin was also demonstrated in well differentiated adenocarcinoma of the gastrointestinal tract. By using a variety of tumor markers, the authors tried to locate possible primary sites in six metastatic skin cancers of unknown origin.