The significance of cutaneous metastasis from visceral tumors diagnosed by fine‐needle aspiration biopsy

Abstract

Cutaneous metastases from various visceral organs were studied in 43 patients. The morphologic diagnosis in each case was established by fine-needle aspiration cytodiagnosis. There were 28 males and 15 females, with median ages of 62 and 61 yr, respectively. The most common primary tumor in men was carcinoma of the lung (35%), followed by malignant melanoma (21%) and carcinoma of the oropharynx (14%). In women, the most frequent primary cancers were carcinoma of the colon (59%) and lung (20%). Metastatic cutaneous lesions were more frequent in the back (23%), upper extremities (21%), and scalp (12%). Median survival from onset of cutaneous metastasis was shortest in primary lung cancer at 3 mo followed by colon at 5 mo and oropharynx at 5.5 mo. Our study confirms that cutaneous metastasis represents a terminal manifestation of the disease due to either hematogenous or lymphatic spread. This study also reiterates the clinical usefulness of needle aspiration biopsy as an alternative diagnostic tool in establishing the presence of cutaneous metastasis.

Fine Needle Aspiration Cytology of Cutaneous and Subcutaneous Metastatic Deposits from Epithelial Malignancies

“…6,7,9,11,12 Also, survival time in the cases presented in this study after the FNAC diagnoses was short (a few weeks to months); that is in agreement with other studies. 4,7 In conclusion, we, like others [4][5][6][7]9,11,12 are of the opinion that FNAC is a safe, minimally invasive and rapid first-line investigation for assessing and confirming the diagnosis of cutaneous/subcutaneous metastases from epithelial malignancies from known and unknown sites. We also think that in cases with simultaneously occurring deposits of carcinoma, FNAC may be useful in investigating the site of a possible primary.…”

“…Although a few reports are cited in the literature on cutaneous metastases, [1][2][3]8 the role of fine needle aspiration cytology (FNAC) as noninvasive first line of investigation has only recently been reported in a few studies. [4][5][6][7][9][10][11][12] This study was designed to analyze cases which presented with a suspicion of metastatic cutaneous/subcutaneous deposits arising either from previously resected tumours or as the first manifestation of an unknown primary carcinoma. The study also emphasizes that appropriate immunoperoxidase studies may be useful in defining the site of the primary carcinoma.…”

Cutaneous Metastasis: A Study of 138 Cases Diagnosed by Fine-Needle Aspiration Cytology

“…In the present 52 study, breast cancer was also the most common site of primary tumor. Cutaneous metastasis may occur by direct extension, local invasion through lymphatics/body cavities, or distant metastasis via the hematogenous or lymphatic route [9][10][11][12] . The complex molecular mechanisms responsible for tumoral metastasis to the skin are not completely understood.…”

Skin metastasis: a pathologist's perspective

“…The average time interval between the diagnosis of primary malignancy and skin metastasis is 33 months, and the average survival following diagnosis was 7.5 months 9 . The median survival times from onset of skin metastases are 3 months (lung cancer), 5 months (colon cancer) and 5.5 months (cancer of oropharynx) 46 . The median survival after skin metastasis of non‐skin squamous cell carcinoma of the head and neck was 8.8 months, cutaneous squamous cell carcinoma: 6.5 months, carcinoma of esophagus: 4.7 months, colorectal cancer: 4.4 months, pancreatic cancer: 3.3 months, stomach cancer: 1.2 months and liver and gall bladder carcinoma: <1 month.…”

“…9 The median survival times from onset of skin metastases are 3 months (lung cancer), 5 months (colon cancer) and 5.5 months (cancer of oropharynx). 46 The median survival after skin metastasis of non-skin squamous cell carcinoma of the head and neck was 8.8 months, cutaneous squamous cell carcinoma: 6.5 months, carcinoma of esophagus: 4.7 months, colorectal cancer: 4.4 months, pancreatic cancer: 3.3 months, stomach cancer: 1.2 months and liver 2,11,12 Bronchogenic carcinoma Trunk and scalp 13 Malignant melanoma Extremities and trunk 14,15 Gastrointestinal carcinomas Abdomen, perianal region, scalp and face 16 -19 Colorectal carcinoma Abdomen, pelvis and around the umbilicus 20,21 Gastric carcinoma Head and neck 16 -19 Hepatocellular carcinoma Fingers, palms, toes, soles and back 22,23 Cholangiocarcinoma Abdomen, site of incision 24 Genitourinary malignancies Abdomen, inguinal region and skin operative scars 25,26 Urothelial carcinomas (urinary bladder) Scrotum, pubic region, inguino-scrotal area and internal face of the left lower limb 25,26 Renal cell carcinoma Extremities, operative scars and scalp 27 -29 Choriocarcinoma (uterus) Chest wall 30 Ovarian carcinoma Lower abdomen 31 Uterine serous carcinoma (endometrium) Lower abdomen, the groin and the upper thigh 32 -34 Meningioma Scar of previous incisions 35,36 Chordoma (vertebral column) Nose, back, scalp and left thigh 37 -39 Head and neck malignancies Head and neck (clavicular region) 40,41 Soft tissue sarcomas Site of the primary tumor or on the scalp 1,42,43 Hematolymphoid malignancies (leukemia) Any site but common on the trunk and extremities 44,45 and gall bladder carcinoma: <1 month. The authors found that 50% of patients with skin metastasis die within the first 6 months after the diagnosis.…”