Metastatic Carcinoma

May 21, 2014

A 60-year-old Caucasian man with a history of invasive squamous cell carcinoma of the lung presents with the lesions shown. Metastases to the skin can be a clinical finding in many malignancies.

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Key point: Metastases to the skin can be a clinical finding in many malignancies, most often breast, lung, colon, melanoma, and head and neck cancers. They can be the first sign of extranodal metastatic disease and most often present as rapidly growing, firm, painless, erythematous nodules. Occasionally, they may be more slowly progressive and can mimic more common entities, such as lipomas, dermatitis, erysipelas, and ulcers. Primary tumors also should be kept on the differential. Cutaneous metastases generally portend a poor prognosis; the average survival time after the diagnosis is 7.5 months. In our case, the patient passed away several days after the diagnosis was confirmed.

Treatment: Depending on the type and stage of malignancy, treatment of cutaneous metastases may include excision, chemotherapy, immunotherapy, and radiation. These treatments often are used as palliative measures.

Note: Perform a full skin examination on any patient who has malignancy or a history of malignancy, especially malignancies that are at an advanced stage. If cutaneous metastases are found, they are a poor prognostic indicator.