J Pathol Transl Med.  2021 Jul;55(4):289-297. 10.4132/jptm.2021.05.24.

Clinicopathologic features of cutaneous metastases from internal malignancies

• Kwon HM
• Kim GY
• Shin DH
• Bae YK

• KMID: 2518429
• DOI: http://doi.org/10.4132/jptm.2021.05.24

Abstract

Background
Cutaneous metastasis (CM) is the spread of cancer cells from a primary site to the skin and is rarely the first sign of silent cancer. We investigated the clinicopathological characteristics of CM from internal malignancies in Korean patients treated at our institution over 20 years.
Methods
The clinicopathological findings of 112 patients (62 females, 50 males) with CM diagnosed at Yeungnam University Hospital between 2000 and 2020 were retrospectively reviewed.
Results
Mean patient age was 58.6 years (range, 26 to 87 years), and the most common primary cancer site was breast (74.2%) in women and lung (36.0%) in men. Ninety-six patients (85.7%) presented with CM after primary tumor diagnosis. CM from the lung or biliary tract usually occurred within 2 years of primary tumor diagnosis, whereas metastases from the breast and kidney occurred several years later. The chest, abdomen, and scalp were common sites of CM. Breast cancer usually metastasized to chest skin, while gastrointestinal tract cancers commonly metastasized to the abdomen. The scalp was a common location for CM from various tumors. The most common dermatologic presentations were nodules and masses. Immunohistochemical studies helped identify underlying malignancies when primary tumors were unknown.
Conclusions
The relative frequency of CM parallels the overall incidence of primary malignant tumors, and CMs usually occur at anatomic sites close to the primary tumor. CM can be diagnosed based on clinical, radiological, and histological features; however, immunohistochemical study is required in some cases.

Keyword

Carcinoma; Metastasis; Skin, Immunohistochemistry

Figure

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  Fig. 1. Metastatic small cell carcinoma of the lung. (A) Tumor cells infiltrated dermal collagen bundles and were diffusely positive for thyroid transcription factor 1 (B) and synaptophysin (C).

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  Fig. 2. Metastatic renal cell carcinoma. (A) The tumor was clear cell type, and tumor cells were positive for vimentin (B) and renal cell carcinoma (C).

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  Fig. 3. Comparison of time interval between diagnosis of primary tumor and occurrence of cutaneous metastasis according to primary tumor site.

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  Fig. 4. Incidence of cutaneous metastasis by anatomic location and primary tumor site.

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  Fig. 5. Representative histologic features and immunohistochemical staining results for metastatic adenocarcinoma of the face. (A) Poorly differentiated adenocarcinoma was mainly located in the dermis. Tumor cells were positive for cytokeratin (CK) 7 (B) and CK19 (C) but negative for thyroid transcription factor 1 (D). Although no primary tumor was confirmed histologically, the metastatic adenocarcinoma was considered of biliary tract origin.

Reference

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