Zosteriform Metastatic Skin Cancer: Report of Three Cases and Review of the Literature

Abstract

Background: Metastatic skin cancer is a rare complication of internal malignancies. Patients who do develop skin metastases seldom present with a zosteriform distribution. Objective: To elucidate the characteristics of zosteriform metastatic skin cancer, 15 cases from the medical literature and 3 cases seen in our clinic were reviewed clinically and histopathologically. Methods: The age and sex of each patient, site of the primary tumor, pathology of primary and metastatic lesions, location of the skin cancer and presence of pain were determined for the 18 cases of zosteriform skin cancer. Results: The most frequent site of the primary tumor was the breast (4 cases), ovary or lung (3 cases each), prostate, bladder or stomach (2 cases each) and uterus or colon (1 case each). The most common site of the skin metastases was the chest wall (8 cases) and abdominal wall (7 cases). The histology of the primary lesion was compatible with adenocarcinoma (10 cases), transitional cell carcinoma or serous papillary cystadenocarcinoma (2 cases each) and ductal carcinoma (1 case). Eleven cases developed on the nearest covering skin and/or on the same side as the primary tumor. Eleven patients complained of pain. Seven cases were treated as herpes zoster with antiviral agents. Conclusion: Approximately 50% of cases of metastatic skin cancer developed on the nearest skin covering and on the same side as the primary tumor. This evidence may be useful when trying to pinpoint the location of the primary tumor. One third of patients with skin metastases were misdiagnosed and their lesions were treated initially as herpes zoster. When a band-like eruption is seen in patients with internal malignancies, the possibility of metastatic skin lesions should be considered. A skin biopsy is necessary to confirm the diagnosis.

Cutaneous lymphangitis carcinomatosa in a patient with lung adenocarcinoma: Case report and literature review

“…In addition to our case, we identified eight other published cases of cutaneous lymphangitis carcinomatosa in patients with lung cancer [9][10][11][12][13][14][15][16] (Table 1). All but one patients suffered from lung adenocarcinoma (histology of lung cancer was not reported for one patient).…”

Zosteriform cutaneous metastases: A case report and brief review of literature

“…It has been reported to occur in 0.7-9% of patients with internal malignancies. [4][5][6][7][8] The clinical features of metastatic skin cancer vary enormously. The most common clinical appearance is that of multiple nodules; less common forms include inflammatory or erysipeloid form, sclerodermoid form, alopecia neoplastica, or bullous form.…”

“…According to a previous report, adenocarcinomas were the commonest histopathological pattern followed by transitional carcinoma. [4] Generally, the histological features of the metastases are similar to the primary tumor, although metastases may be more anaplastic and exhibit less differentiation. [17] The distribution of such metastases while variable appears to be related to both their mode of spread and the location of the primary tumor.…”

Bulky cutaneous metastasis from lung cancer

“…Patients rarely complain of pain at the site of the metastasis, however severely painful zosteriform lesions could result from penetration of the dorsal root ganglions [6].…”