Cutaneous metastasis from pancreatic cancer: A case report and systematic review of the literature

Abstract

Cutaneous metastasis from pancreatic cancer is uncommon, therefore, the outcome of this progression has rarely been investigated. The aim of the present report was to evaluate the clinical characteristics of patients exhibiting cutaneous metastasis from pancreatic cancer. Thus, the current report presents a rare case of cutaneous metastatic disease from pancreatic cancer and describes a systematic review of the literature. A total of 54 articles comprising 63 cases were included for analysis. The relevant clinical and pathological characteristics, as well as the treatment strategies and survival outcomes of this rare disease presentation were reviewed. The average patient was was aged 63.9 years and males constituted a marginally greater proportion of the cohort (61.9%). The predominant manifestation of the cutaneous metastasis was a nodule or mass (73%) and the most common site of the skin lesion was non-umbilicus rather than umbilicus. The majority (66.7%) of the skin lesions were singular, particularly in patients exhibiting Sister Mary Joseph’s nodule (90%). A wide range of histological subtypes presented, with a predominance of adenocarcinoma (84.1%). Of the cases that specified the tumor differentiation grade, 78.2% were moderately or poorly differentiated. Immunohistochemistry revealed that cytokeratin (CK)20-negative, and CK7-, CK19- and carbohydrate antigen (CA)19-9-positive were specific diagnostic markers for pancreatic cancer. Distal metastases, excluding the skin, were observed in 68.3% of patients and the median survival period was 5 months. Treatment strategies including surgery, radiation, chemotherapy or a combination improved survival time from 3.0 to 8.3 months. Cutaneous metastasis from pancreatic cancer is a rare finding, often providing the only external indication of an internal malignancy and, therefore, should be considered in the differential diagnosis of skin lesions. Metastasis to the skin indicates a widespread, general dissemination and a poor prognosis. A combination of surgery, radiotherapy and chemotherapy appears to result in improved survival rates.

Cutaneous Metastasis of a Mucoepidermoid Carcinoma of the Pancreas: First Reported Case

“…The most common sites of metastases are liver and peritoneum followed by lungs, bones, and brain. 1 Most published literature note that cutaneous metastases of pancreatic cancer are infrequent, however, when present they are predominantly seen in the periumbilical area, also known as Sister Mary Joseph's nodule. [2][3][4][5] In contrast, in a recent systematic review of the literature of cutaneous metastases in pancreatic cancer performed by Zhou et al 1 in 2014, the most common site of skin metastases were noted to be nonumbilical rather than umbilical.…”

Metastatic pancreatic adenosquamous carcinoma to the scalp: A case report and review of the literature

“…The present case is the first specific report of pancreatic adenosquamous carcinoma metastasizing to the scalp. To the best of our knowledge, pancreatic adenosquamous carcinoma metastasizing to the non‐scalp skin has been reported only in one patient . These relatively rare tumors are larger and more commonly found in the body or tail of the pancreas.…”

A special discovery of pancreatic adenocarcinoma by Sister Mary-Joseph’s Nodule: what is the prognosis?

“…Direct extension of peritoneal lesions remains the most common mechanism. Hematogenous dissemination or lymphatic extension along with ligaments of embryonic or iatrogenic origin during laparoscopy is reported [9] . It concerns essentially adults with equal sex ratio [2] .…”