3.3.10 Cutaneous Metastases
Grading & Level of Importance: C
Prevalence is around 2 %, incidence varying from 8 - 10% . In up to 10% of visceral tumors skin manifestation is the first sign, most commonly in breast, colon and lung carcinomas as well as in leukemias.
Cutaneous spread of malignant tumours of internal organs or hematological system, direct penetrating or via blood vessels, perineural sheet or lymphatics.
Aetiology & Pathogenesis
There is no clear pathological mechanism behind why metastases spread to the skin except by direct penetrating. Some homing factors can play a role in leukemia dissemination. Sometimes skin metastases hone into herpes zoster scars.
Signs & Symptoms
Solitary or multiple, aggregated, zosteriform or disseminated firm blue-red to yellow papules and nodules in various levels of the skin with rapid growth with a short history. Sometimes erysipelas or lymphangiosis-like pattern (cancer en cuirasse ) in breast cancer.
If the skin metastasis is contiguous with the underlying primary, the precise type of cancer may be deduced, however this is usually not the case.
Special localisations of metastasis
- Breast cancer metastases are often thoracic
- Prostate: suprapubic
- Sister Mary Joseph nodules located at the umbilicus derive from the ovarian and gastro-intestinal origin
Oesophageal, gastric and colonic cancers, biliary tract, pulmonary and renal carcinomas prefer hairy scalp, neck and face.
No clear classification of cutaneous metastases.
Laboratory & other workups
Histological, immunohistochemical or molecular in conjunction with tumor screening.
Immunohistochemical profiling of tumor cells.
Often metastases appear in tumor-free interval. Survival after detection of metastases in most cases less than 1 year.
Depending on the type of primary tumor, stage and pretreatment. Some metastases melt away, become necrotic, bleed or become superinfected.
Metastasis has to be considered in case of a rapidly growing non-classifiable lesion in the skin.
Primary skin tumours and primary skin lymphomas, granulomatous inflitrates.
Prevention & Therapy
There is no prevention. Histological evaluation is a first step to decision algorithms for therapy of the primary tumor.
Interdisciplinary approach and tumor boards to be involved.
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