No abstract

Patients with lung cancer may present with respiratory and systemic symptoms. However, cutaneous metastases from primary lung cancer is a rare phenomenon, especially in women, that signifies a poor prognosis. This paper reported a case regarding a 71-year-old woman who was first presented with a cutaneous nodule over the year. Her condition was further progressed to multiple lesions on the back and abdomen, dyspnoea, haemoptysis and weight loss. The results of the skin lesion biopsy exhibited metastatic lung adenocarcinoma with positive immunohistochemistry for thyroid transcription factor 1 (TTF1) and cytokeratin 7 (CK7). Computed tomography (CT) scan was conducted, and it revealed a left upper lobe lung mass. The patient was subsequently scheduled for additional management, but she had succumbed to complications of pulmonary embolism before the necessary interventions could be provided. In this particular case presentation, the biopsy of cutaneous lesions obtained had revealed an undiagnosed primary malignancy.

Case Presentation A 69-year-old Malay lady was referred to the dermatology clinic with complaint of painful nail-beds of fingers and toes for the past 10-weeks. She was recently diagnosed with non-small cell lung carcinoma stage 1V and was started on oral Afatinib 40 mg, then tapered to 30 mg daily after 2 weeks due to severe oral ulcers which then improved. Four weeks post-treatment she started noticing acute nail symptoms, her fingers and toes being were swollen, red and tender. She also had intermittent diarrhoea. There were no other associated symptoms of fever, rash, arthritis and numbness. No history of trauma or history of pedicure and manicure. Further history she also revealed that she had blackish discoloration of the left big toenail for 3-years. She is a non-smoker, no significant family history and no past medical history. She had history of hysterectomy in 1997 due to fibroids and is now a retired economist living with her husband and has no children. Prior to referral to dermatologist she was treated with a week of oral Erythromycin 400 mg bd for suspected bacterial induced paronychia, with topical fucidin and clotrimazole bid, by her oncologist, but condition did not improve. Blood results showed full blood count Hb-12.4 g/dl, WBC-5.8x109 /l, Platelet-369x109 /L. Renal profile and Liver function test were normal. ESR was 21 mm/hr. Calcium, phosphate and fasting blood glucose also in normal range. Based on the pictures below, what is the most likely diagnosis? Figure 1 (a) Bilateral middle and index fingers showed grade 1-2 paronychia (nail-fold erythema and oedema). Right thumb had grade 2 paronychia (centre picture) with bogginess or 'pyogenic-granuloma like' eruption