Distant cutaneous metastases of cholangiocarcinoma: Report of two cases of a previously unreported condition

Cutaneous Metastasis from Cholangiocarcinoma as the First Clinical Sign: A Report of Two Cases

“…2 Moreover, cutaneous metastases from cholangiocarcinomas have only been reported in two patients in whom a cutaneous lesion was the first sign of the carcinoma (Table 1). 4,5 In both of these patients, the cutaneous lesion was found on the scalp. In one, there was a poorly circumscribed, firm, subcutaneous nodule on the occipital area, and the lesion was approximately 2 cm in diameter with slight tenderness and erythema.…”

“…In one, there was a poorly circumscribed, firm, subcutaneous nodule on the occipital area, and the lesion was approximately 2 cm in diameter with slight tenderness and erythema. 4 The other patient had a well-circumscribed, indurated, painless ulcer on his scalp, which was fixed to the underlying tissue. 5 Both patients had erythematous, subcutaneous nodules on the scalp, and one of them also presented with an ulcerofungating mass on the back.…”

“…3 Cholangiocarcinoma is a neoplasm of the bile duct, which frequently invades or metastasizes to adjacent organs or other visceral organs, such as the lungs, bones, adrenal glands, and brain. 4,5 Cutaneous metastases of cholangiocarcinoma are extremely rare and have been reported to occur in only 0.4-5.3% 6,7 of cases. Most of the literature reporting cutaneous metastases of cholangiocarcinoma describes cases in which cancer cells were disseminated through catheter tracts used for percutaneous biliary drainage, or cases where cutaneous metastases were discovered after the diagnosis of cholangiocarcinoma was made.…”

“…3 Previous reports indicate that the most common presentation of cutaneous metastases of cholangiocarcinoma is the nodular type; other skin lesions described include erythematous plaques, abscesses, and ulcers. [4][5][6][7][8][9][10][11] Most nodular lesions are firm, painless, and nonulcerative and covered by a normal appearing epithelium; this results in some lesions being misdiagnosed as benign. Clinicians should therefore consider the possibility of cutaneous metastases when examining patients with skin nodules, especially those with a history of malignancy.…”

“…Lu et al demonstrated that the valveless vertebral venous plexus communicates above with the intracranial venous sinuses, and segmentally with the veins of the thorax, abdomen, and pelvis. 4,12 Metastatic skin lesions, therefore, occur on the scalp more frequently than in other areas.…”