Cutaneous Metastasis

September 14, 2005
Ted Rosen, MD
Ted Rosen, MD

A 68-year-old man presented with a sudden-onset, 2.5 × 2-cm, rock-hard, erythematous, nontender nodule on the right side of the chest. A dense mat of telangiectases surrounded the solitary lesion. The remainder of the cutaneous examination was unremarkable.

A 68-year-old man presented with a sudden-onset, 2.5 × 2-cm, rock-hard, erythematous, nontender nodule on the right side of the chest. A dense mat of telangiectases surrounded the solitary lesion. The remainder of the cutaneous examination was unremarkable.

The differential diagnosis of the lesion, which was clearly a tumor, included both primary cutaneous neoplasia (particularly squamous cell carcinoma, nodular amelanotic melanoma, and various sarcomas) and cutaneous metastasis from an occult focus of an internal carcinoma. A biopsy revealed pleomorphic cells arranged in glandlike tubular structures embedded in a richly vascular stroma; this finding strongly suggested a renal cell carcinoma.

A thorough systemic evaluation revealed a primary tumor that involved the right kidney and asymptomatic hepatic and osseous metastases. The patient declined therapy and was lost to follow-up.

About 2% to 5% of all visceral malignancies result in cutaneous metastases.1 Of particular note: the first sign of renal cell and bronchogenic carcinomas may well be skin metastases.

REFERENCE:1. Rosen T. Cutaneous metastases. Med Clin North Am. 1980;64:885-900.