Cutaneous Metastasis

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Key points

  • Cutaneous metastases may be the first sign of an internal malignancy and in general portend a poor prognosis. The incidence is increasing due to improved survival of patients with cancer as a whole.

  • Although most cutaneous metastases will classically appear as a dermal nodule, there have been a wide range of clinical appearances reported, many of which are described in this article.

  • Breast cancer and melanoma are the most common cancers to spread to/within the skin, but other malignancies (such

Melanoma

Malignant melanoma is the most common cancer to metastasize to the skin (see Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6).3, 9 The typical clinical appearance is a pigmented papule or nodule (see Fig. 1), although amelanotic lesions have been also reported.10 These lesions can often progress in size, ulcerate, and bleed leading to significant patient morbidity.10

The incidence of skin metastasis in patients with melanoma ranges from 2% to 20%11, 12, 13; however, a more recent study of 2865

Breast cancer

In women, breast cancer (see Fig. 7) is the most common primary cancer to metastasize to the skin (see Figs. 2, 3, and 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25).2, 3 Metastases typically appear on the anterior chest wall, typically from lymphatic extension to the overlying skin, in the form of skin-colored nodules (see Fig. 8, Fig. 9, Fig. 10).20, 21 Among the histologic subtypes of breast cancer, adenocarcinoma has the highest rate of skin metastasis, ranging from

Other solid tumors

A review of literature by Kovacs and colleagues29, 30 reported that an overall incidence of cutaneous metastasis of 2.9% in cases of primary solid visceral malignancies. The investigators determined that lung, renal, and colorectal cancer have a metastatic preference for the skin, implying a biologic predilection for skin metastasis in these cancers. In contrast, this group reported a negative preference in gastric, liver, and pancreatic cancers.31

Hematologic malignancy

Leukemia cutis refers to extramedullary infiltration of neoplastic leukocytes into skin, resulting in clinically identifiable cutaneous lesions (see Fig. 20, Fig. 21, Fig. 22, Fig. 23, Fig. 24, Fig. 25, Fig. 26, Fig. 27, Fig. 28, Fig. 29, Fig. 30, Fig. 31, Fig. 32). In contrast to primary cutaneous lymphomas (eg, mycosis fungoides, a cutaneous T-cell lymphoma), the malignant cells in leukemia cutis do not normally have a predilection for the skin. Acute myeloid leukemia (AML) is the most likely

General approach to therapy

A review article by Wong and colleagues20 in 2013 recommended excision of cutaneous metastases when surgically feasible and when it will result in a significant decrease in total tumor burden, improve the quality of life, or increase functionality. Using metastatic melanoma as a model, the investigators suggested 1-cm excision margins, with the caveat that no great data exists regarding excision margins of metastatic disease.20

In general, treatment follows the regimen appropriate for the

Summary

It is understood that cutaneous metastases tend to appear on the skin overlying the region of the primary tumor, a phenomenon that has been best described in lung and breast cancer.3 However, these regional skin metastases are certainly not always the case. In the case of RCC, its aggressive propensity to spread hematogenously allows neoplastic cells to appear on the scalp (see Fig. 27).39 Although breast cancer may also appear on the scalp, in a clinical condition termed alopecia neoplastica

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      Citation Excerpt :

      Partial resolution was seen with plasmapheresis and with improvement of renal function. Overall, skin metastases appear in about 1–9% of all patients with cancer and as such the skin is an uncommon site of metastatic disease when compared to other organs.41,42 Lesions in the skin usually appear a long time after the diagnosis of the primary malignancy.41,42

    View all citing articles on Scopus

    Disclosure Statement: J.Y. Jung - Regeneron: Principal investigator, Consultant; Merck: Principal investigator; Iderra: Principal investigator; Adgero: Consultant; Amgen: Consultant, Speaker.

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