Clinical analysis of patients with skin metastasis of cervical squamous cell carcinoma.

BACKGROUND: Cancers that metastasize to the skin are rare, especially cervical squamous cell carcinoma to the skin. Here, we have reported clinical analysis of patients with cervical squamous cell carcinoma metastasize to skin, to obtain a general understanding of this malignancy for clinicians. METHODS: A retrospective analysis of patients with skin metastasis from cervical squamous cell carcinoma was conducted, focusing on clinical manifestations, histopathology, diagnosis, treatment, and prognosis. RESULTS: The average age of onset for the six patients with skin metastasis from cervical squamous cell carcinoma was 55.17±17.08 years, with four cases presenting as solitary lesions and two cases as multiple lesions. Treatment strategies included local excision for isolated lesions, chemotherapy, radiotherapy, or targeted therapy based on the extent of skin involvement, and immunotherapy was proved to have promising results in our cases. Among the six patients, three have passed away with a diagnosis-to-death time of approximately 5-6 months, while three patients are alive, with survival times ranging from 30 to 72 months. CONCLUSIONS: Skin metastasis from cervical squamous cell carcinoma is rare and often accompanies recurrent metastases to other visceral sites, necessitating early and accurate diagnosis. For isolated metastatic lesions, early detection followed by wide excision surgery and adjuvant radiotherapy can yield favorable outcomes. However, in cases of multiple skin metastases or concurrent metastases to multiple organs, treatment is challenging with a poor prognosis. Nevertheless, with advancements in medicine, combination chemotherapy, immunotherapy, and targeted therapy can effectively prolong survival, offering new hope for patients with skin metastasis from cervical cancer.

Radiation for inflammatory breast cancer: Updates.

Inflammatory breast cancer (IBC) is a diagnosis based on a constellation of clinical features of edema (peau d'orange) of a third or more of the skin of the breast with a palpable border and a rapid onset of breast erythema. Incidence of IBC has increased over time, although it still makes up only 1-4% of all breast cancer diagnoses. Despite recent encouraging data on clinical outcomes, the published local-regional control rates remain consistently lower than the rates for non-IBC. In this review, we focus on radiotherapy, provide a framework for multi-disciplinary care for IBC, describe local-regional treatment techniques for IBC; highlight new directions in the management of patients with metastatic IBC and offer an introduction to future directions regarding the optimal treatment and management of IBC.

Centrifugally Spreading Annular Erythema as a Dermatological Indicator of Metastatic Breast Carcinoma.

Breast cancer is the leading cause of skin metastasis in women with internal malignancies. This report highlights an atypical case of cutaneous metastasis of breast cancer (CMBC) in a 66-year-old woman. Starting four months before her dermatology consultation, the patient underwent a chemotherapy regimen comprising pertuzumab, trastuzumab, and vinorelbine for right breast cancer, right axillary lymph node enlargement, and bone metastases. After commencing chemotherapy, erythematous macules appeared around her right nipple. Subsequently, the cutaneous lesions developed into annular erythematous patches around her right nipple and began to coalesce and expand to the contralateral breast. A skin biopsy revealed dysplastic cells indicative of metastasis from invasive ductal carcinoma. In addition, lymphovascular tumor cell invasion was noted in the reticular dermis. Based on these clinical progressions and histopathologic findings, a diagnosis of CMBC was made, specifically considering the possibility of inflammatory breast cancer (IBC). The patient continued the same chemotherapy regimen for 17 cycles, which improved the skin lesions, but she succumbed to breast cancer two years later. This case emphasizes the importance of considering CMBC in breast cancer patients with expanding, treatment-resistant thoracic cutaneous lesions, especially in aggressive subtypes like IBC. The diverse presentations of CMBC require thorough histopathological evaluation.

Cutaneous metastasis of lung cancer: Case report.

Lung cancer is one of the most common cancers in men, and is often diagnosed at the metastatic stage. It often leads to lung, bone, brain, liver, and adrenal metastases. However, unusual secondary locations are possible, such as skin metastases, which are often associated with a poor prognosis. We report a case of lung cancer revealed by a subcutaneous mass on the forehead.

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.

18F-FDG PET/MRI Image of Skin Metastasis of Ovarian Cancer.

Ovarian cancer is one of the deadliest tumors among women. It mostly metastasizes to the liver, pleura, lungs, and bones. We present a sixty-six-year-old patient with skin lesions. The patient who underwent biopsy due to skin lesions was diagnosed with ovarian cancer. 18F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) performed for metastasis search shows widespread skin involvement, especially in the lower abdomen and legs. Skin involvement it ovarian cancer can be rarely seen, and in this article we would like to share 18F-FDG PET/MRI of skin involvement in ovarian cancer.

Cutaneous metastasis as the first presentation of poorly differentiated renal cell carcinoma: A case report.

Renal cell carcinoma (RCC) exhibits a propensity for unusual wide metastasis. Cutaneous metastasis from RCC is a rare and poorly recognized clinical entity. We present a case of cutaneous metastasis of poorly differentiated RCC in 49-year-old male patient. In the presented case, the skin lesion was the first sign of widely spread RCC. After the establishment of the diagnosis using radiological and histopathological assessments, the patient was labeled as a terminal case and was referred for pain management. He deceased after 6 months of the initial presentation.

Pembrolizumab combined with axitinib in the treatment of skin metastasis of renal clear cell carcinoma to nasal ala: A case report.

BACKGROUND: Renal clear cell carcinoma (RCC) is a malignant tumor of the genitourinary system with a predilection for males. The most common metastatic sites are the lung, liver, lymph nodes, contralateral kidney or adrenal gland, however, skin metastasis has only been seen in 1.0%-3.3% of cases. The most common site of skin metastasis is the scalp, and metastasis to the nasal ala region is rare. CASE SUMMARY: A 55-year-old man with clear cell carcinoma of the left kidney was treated with pembrolizumab and axitinib for half a year after surgery and was found to have a red mass on his right nasal ala for 3 mo. The skin lesion of the patient grew rapidly to the size of 2.0 cm × 2.0 cm × 1.2 cm after discontinuation of targeted drug therapy due to the coronavirus disease 2019 epidemic. The patient was finally diagnosed with skin metastasis of RCC in our hospital. The patient refused to undergo surgical resection and the tumor shrank rapidly after resuming target therapy for 2 wk. CONCLUSION: It is rare for an RCC to metastasize to the skin of the nasal ala region. The tumor size change of this patient before and after treatment with targeted drugs shows the effectiveness of combination therapy for skin metastasis.

BRAFV600E and TERT promoter C228T mutations on ThyroSeq v3 analysis of delayed skin metastasis from papillary thyroid cancer: a case report and literature review.

BACKGROUND: Skin metastasis from papillary thyroid cancer (PTC) is a rare entity that can occur up to decades after treatment of the primary tumor. Here, we present a patient who developed skin metastasis 10 years after treatment of her primary tumor and describe the molecular findings of the metastatic lesion. CASE PRESENTATION: A 44-year-old female with a history of PTC who underwent a total thyroidectomy and radioactive iodine (RAI) treatment 10 years ago presented with a 1.3-cm skin lesion along the prior thyroidectomy scar. A biopsy revealed metastatic PTC, and the patient underwent surgical excision of the lesion. ThyroSeq molecular testing showed the copresence of BRAFV600E mutation and TERT promoter C228T mutation. The patient subsequently received one round of adjuvant RAI therapy. CONCLUSIONS: A high index of suspicion is warranted in patients with a history of PTC who develop a skin lesion, even several years after remission of the primary disease. In patients with high-risk mutations, such as BRAFV600E and TERT promoter C228T mutations, long-term surveillance of disease recurrence is particularly important.

Non-iatrogenic implantation of cutaneous metastasis from hepatocellular carcinoma.

PURPOSE: Cutaneous metastases as an extrahepatic metastasis from hepatomas (HCC) is extremely rare and always carry a poor prognosis and less survival time. Previously, there has been a limited number of literature that reported skin metastasis in a large number of cases, which has rarely been discussed in the empirical treatment and therapy of cutaneous metastasis, especially for non-iatrogenic implantation. It is necessary to discuss this kind of metastasis. PATIENTS AND METHODS: We summarize cases from our medical center from 2013 to 2021, there are 12 patients diagnosed with non-iatrogenic implantation of cutaneous metastasis after HCC. We conducted the investigation of the clinical prognosis, pathological characteristics, and treatment of those patients. RESULTS: All patients were male, the age ranged from 21 to 71 years old, the average size of primary HCC was over 5 cm, there was four patient's cutaneous metastasis from the skin of head (including scalp and occipital region), followed by right abdominal (2 patients), right chest wall (2 patients), back (2 patients), umbilical (1 patient), gluteal region (1 patient). The cutaneous metastases presented as solitary or multiple nodules, papules, and erythema without ulcers with sizes between 0.5 cm and 5 cm. 7 patients died after being diagnosed with cutaneous metastasis within 2-19 months. CONCLUSIONS: The rate of non-iatrogenic implantation cutaneous metastasis is low, but the prognosis is poor, combining with histopathological analysis and history of diseases can be helpful in diagnosis. For large HCC (> 5 cm), systematic treatment is recommended to prevent the occurrence of cutaneous metastasis and improve the prognosis after hepatectomy.

The Importance of Reading the Skin: Cutaneous Metastases of Pancreatic Cancer, a Systematic Review.

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.

Cutaneous metastasis of unknown origin: Dermatologic features and pathology

Background@#Skin metastases are rare yet crucial indicators of advanced disease. They can mimic various skin conditions, making them challenging to diagnose.@*Aims and Objectives@#To investigate the incidence rate of biopsy-confirmed cutaneous metastasis and explore the clinical presentation, workup, and diagnostic techniques for skin metastases@*Materials and Methods@#Local study involving comprehensive laboratory tests, pathological examination, and immunohistochemistry to identify primary tumors and confirm diagnoses. @*Results@#Nodules were the most common manifestation of skin metastases, particularly in breast carcinoma. The chest wall and abdomen were frequent sites of involvement. Pathological examination and immunohistochemistry played a critical role in confirming diagnoses, revealing various histopathologic patterns. Immunohistochemical markers assisted in determining tumor origin but required careful interpretation. Monitoring tumor behavior over time provided insights into nature and origins. @*Conclusion@#Comprehensive workups including laboratory testing, pathology, and immunohistochemistry are essential for accurate diagnosis and management of skin metastases. Careful monitoring of tumor behavior can provide valuable information about its nature and origins.

Edema of limbs as the primary symptom of gastric signet-ring cell carcinoma: A case report and literature review.

BACKGROUND: Metastatic skin cancers are relatively rare dermatological malignancies. They usually present as nodules, erythematous lesions, scar-like lesions or other lesion types. Signet-ring cell carcinoma (SRCC) is an uncommon histological type of gastric cancer that usually behaves aggressively and has a poor prognosis. Skin metastasis may be the first sign of clinically silent visceral cancer or recurrence of an internal malignancy. CASE SUMMARY: Herein we report on the case of a 55-year-old man with edema of a lower extremity as the primary symptom which progressed from local to generalized pitting edema in the year following skin involvement. Pathological evidence from gastroscopic specimens and subcutaneous tissue biopsy showed typical signet-ring cells and gland-like structures. Consistently, immunohistochemical analysis revealed positive pan-cytokeratin expression in tumor cells. A diagnosis of gastric SRCC with skin metastasis was established. Moreover, lymphoscintigraphy showed an obvious accumulation of radiotracer on the anterior and posterior sides of the right leg which indicated lymphedema. We reviewed the relevant literature on subcutaneous metastases of gastric SRCC. CONCLUSION: This rare case emphasizes the importance of physical examination as it may help elucidate the etiology of edema.

Sister Mary Joseph's Nodule From Renal Cell Carcinoma: A Case Report.

Sister Mary Joseph's nodules (SMJNs) are umbilical skin metastases of various abdominopelvic malignancies, and they rarely originate from renal cell carcinomas. Radiotherapy is typically used to treat the nodules as a palliative intention. We report a rare case of SMJN that originated from clear cell renal cell carcinoma, which was treated with external beam radiation therapy (EBRT) and interstitial brachytherapy (ISBT). A 74-year-old male patient with a history of left renal cell carcinoma developed an umbilical nodule which was diagnosed as SMJN. The patient underwent EBRT (30 Gy in 10 fractions) and ISBT (12 Gy in two fractions), leading the nodule to complete resolution. This case report might support that radiotherapy, including ISBT, is effective for the treatment of SMJN from renal cell carcinoma.

Metastasis of malignant pleural mesothelioma to the scalp following chemotherapy: A case report and review of the literature.

Malignant pleural mesothelioma is a neoplasm involving mesothelial cells of the pleura. Both local and distant metastases may develop, although the latter are less common and it is extremely rare for cutaneous metastases to appear as a solitary lesion on the scalp. We present the case of a 54-year-old woman with a 2-year history of unresectable left pleural mesothelioma treated with chemotherapy, who had developed a painful lump on the scalp one month prior to consultation. Skin metastases of mesothelioma must be differentiated from primary neoplasms, and immunohistochemistry is fundamental to determine the origin of such lesions, which can be correctly identified through the use of a panel of markers.

Primary ascending colon cancer accompanying skip metastases in left shoulder skin and left neck lymph node: A case report.

BACKGROUND: Lymph node skip metastases are common in lung, breast, and thyroid cancer patients, but are rare in colon cancer patients. Specifically, lymph node skip metastases occur in 1%-3% of colon cancer patients. Previous reports have demonstrated colon cancer skip metastases involving the retropancreatic and portocaval lymph nodes and Virchow's node; however, reports involving skip metastases into the left neck lymph nodes and left shoulder skin are extremely rare, as are related reports of clinical treatment and prognosis. CASE SUMMARY: A 44-year-old Chinese man was admitted to the hospital for evaluation of persistent shoulder pain for 3 d and a cutaneous mass (3.0 cm × 2.0 cm) on the left shoulder. The left shoulder cutaneous mass was excised and bisected, revealing tissues with a fish-like appearance. The pathologic diagnosis of the cutaneous mass suggested a signature [CDX-2 (++), CK20 (++), Ki-67 (+) > 50%] of infiltrating or metastatic colorectal adenocarcinoma. An enhanced computed tomography scan of the abdomen revealed chronic appendicitis with fecal stone formation, cecal edema, and a pelvic effusion. A colonoscopy revealed a cauliflower-like mass within the ascending colon area that involved the lumen. The surface of the ascending colon mass was eroded and bleeding; a biopsy was performed. The pathologic diagnosis of the colonoscopy biopsy was an ascending colon mucinous adenocarcinoma. The patient underwent a laparoscopic radical resection of the right colon based on the pathological diagnosis. The tumor was 5.0 cm × 4.5 cm × 1.8 cm in size and infiltrated the entire thickness of the intestinal wall with vascular tumor thrombi. No nerve tissue involvement was noted. The ileum and colon resection margins were negative. The postoperative pathologic analysis revealed non-metastatic involvement of ileocecal, pericolic, or peri-ileal lymph nodes. The postoperative medical examination revealed palpably enlarged lymph nodes in the left neck, and the following color Doppler ultrasound examination of the neck confirmed enlarged lymph nodes in the left neck. After surgical resection and pathologic diagnosis, a common pathologic signature consistent with resected cutaneous mass and right colon was identified, suggesting skip metastasis of left cervical lymph nodes. The patient was then treated with eight courses of chemotherapy and under follow-up evaluations for 4 years; currently, no tumor recurrences or metastases have been noted. CONCLUSION: We report an abnormal skip metastasis involving the left shoulder skin and left neck lymph node in a patient with ascending colon adenocarcinoma. Specifically, we observed non-metastatic involvement of the lymph nodes around the tumor site but with metastases to the cervical lymph nodes. The standard surgical operations were performed to resect the cutaneous mass, tumor tissue, and cervical lymph nodes, followed by chemotherapy for eight courses. The patient is healthy with no tumor recurrences or metastases for 4 years. This clinical case will contribute to future research about the abnormal skip metastasis in colon cancers and a better clinical treatment design.

Papillary Thyroid Cancer Presenting with Incidental Skin Lesion: Critical Management of Distant Metastasis.

Papillary thyroid cancer can usually metastasize to neck lymph nodes. Distant metastases are generally seen as solid organ metastases, in contrast, skin metastasis can rarely be seen. We present a case with papillary thyroid cancer diagnosed with skin metastasis as first clinical sign of distant organ metastasis. A 63-year-old male patient admitted with a skin lesion in the left lateral neck. He had undergone subtotal thyroidectomy 14 years ago without relevant history of malignancy. Follicular variant papillary thyroid cancer was detected in the excisional biopsy performed from the cutaneous lesion. A 12 × 10 × 8 mm hyperechoic nodule in the left lobe was detected in USG and evaluated as Bethesta-III in fine needle aspiration biopsy. Bilateral multiple lung metastases were detected on thorax CT, trucut-biopsied from largest nodule and confirmed as metastasis. Carcinoma was not detected in total thyroidectomy, and post-operative multiple RAI therapies were applied. Patients without history of thyroid cancer rarely present with skin metastases and thyroid cancer should not be overlooked in differential diagnosis. Despite meticulous evaluation of the thyroidectomy specimen, tumor may not be detected in the gland. Skin metastasis in papillary thyroid cancer should be evaluated as distant metastasis and investigations for other metastases should be done, and the treatment should be planned in a multidisciplinary manner.

Cutaneous Metastasis of Carcinoma Buccal Mucosa: A Rare Presentation.

Cutaneous metastasis (CM) of head-and-neck squamous cell carcinoma is rarely reported. Here, we report a case of a 78-year-old male who had already had a surgically treated case of carcinoma of the right buccal mucosa one and a half months back but presented with a near local site recurrence and subsequently developed distant skin metastases to the lower neck and upper trunk during treatment. Local site recurrence was confirmed with a biopsy, but benign-looking lesions in the lower neck and upper trunk were developed during the last week of treatment, which later on kept growing in size and after the biopsy came positive for malignancy. Although there was a complete response at the recurred site of malignancy, there was a progression of disease at the initially benign-looking lesion in the lower neck and upper trunk, which later on was proven to be cutaneous malignancy on histopathology. This case has cemented the fact that the chance of the presence of occult skin metastasis at the time of diagnosis in primary or recurrent malignancies. Thus, tissue biopsy should be done with a high index of suspicion for cutaneous malignancy associated with head and neck cancers.