The presentation, pathology, and current management strategies of cutaneous metastasis

Abstract

Skin metastases are rare in the routine clinical practice of dermatology, but are of major clinical significance because they usually indicate advanced disease. We reviewed the literature on skin metastasis regarding recent trends in clinical presentation and diagnosis of the most common cutaneous lesions. An extensive literature review was conducted using PubMed from May 26, 2011 to July 16, 2013 relating cutaneous metastases. Articles chosen for reference were queried with the following prompts: “Cutaneous metastases”, “clinical presentation”, “histological features”, and “immunohistochemistry”. Further searches included “treatment” and “management” options for “metastatic breast”, “metastatic colorectal”, “metastatic melanoma”, “metastatic lung”, and “hematologic cancers.” We also reviewed the literature on the current management of melanoma as a model for all cutaneous metastatic disease. Our own clinical findings are presented and compared to the literature. Additionally, we highlight the most useful immunohistochemical studies that aid in diagnoses. Several novel therapies and combination therapies such as electrochemotherapy, vemurafenib, and imiquimod will be discussed for palliative treatment of cancers that have been found to improve cutaneous lesions. We review these notable findings and developments regarding skin metastases for the general dermatologist.

Cutaneous metastasis from solid organ cancer: A histopathological and immunohistochemical study of 74 cases from a tertiary care centre of North India

“…Cutaneous metastases can occur at any site, most common being the anterior trunk, and head and neck. 4 They usually present as painless swellings, mostly hard nodules or nodulo-plaque lesions, similar to our finding. However, in 15% of cases, multiple cutaneous nodules were seen in our study.…”

Lung Sarcomatoid Carcinoma Metastasis to Skin: A Case Report and Review of the Literature

“…Because of the rarity of this form of malignant tumor, there is no consensus on the proper treatments such as surgical management, chemoradiotherapy. Considering excising the skin metastasis was surgically feasible and might help prolong the survival time since this could decrease total tumor burden (22,42), the surgery was adopted for this case, which would provide sufficient tissue for biopsy to draw a precise diagnosis at the same time. The patient expired 6 months after the skin biopsy.…”

Breast Cancer Metastasis Misdiagnosed as an Angiokeratomatous Eruption. An Infrequent Presentation. Case Report

“…3 Among all visceral neoplasms that metastasize to the skin, breast cancer is the most common, accounting for 32.7% of all skin metastases. 4 The most common clinical presentation is as a rapidly growing painless dermal or subcutaneous nodule. 4 The most common clinical presentation is as a rapidly growing painless dermal or subcutaneous nodule.…”

“…3 Cutaneous metastases from breast carcinoma (CMBC) may be asymptomatic or associated with pain and tenderness. 2,4 Other less common presentations include inflammatory dermatosis, hairless plaques, and morphea-like plaques, among others. 2,4 Other less common presentations include inflammatory dermatosis, hairless plaques, and morphea-like plaques, among others.…”

“…4 The most common clinical presentation is as a rapidly growing painless dermal or subcutaneous nodule. 2,4 However, there are no reports of CMBC resembling eruptive angiokeratomas. 2,4 However, there are no reports of CMBC resembling eruptive angiokeratomas.…”