Background

Metastatic tumors to the skin may occasionally be the first manifestation of a cancer. Unfortunately, when this occurs, the cancer is usually advanced. The incidence and type of metastases varies by age, sex, and tumor type.

Skin metastases was the initial presenting manifestation of the cancer in 0.8% of 7316 cancer patients.
See table below.
(J Am Acad Dermatol 1999;22:19)

Cancer	Percentage % of tumors as initial sign of disease
Lung	60
Renal Cell	53
Ovarian	40

Non-Hematopoietic Cutaneous Metastases In Children and Adolescents
(J Cutan Pathol 2000;27:485-492)

Cancer	Cases n=34
Neuroblastoma	8
Rhabdomyosarcoma NOS	6
Rhabdomyosarcoma, embryonal	4
Rhabdomyosarcoma, alveolar	4
Osteosarcoma	2
Choriocarcinoma	2
Peripheral neuroepithelioma or Ewing's sarcoma	2
Malignant rhabdoid tumor	1
Paraganglioma	1
Nasopharyngeal carcinoma	1
Colon adenocarcinoma	1
Malignant melanoma	1
Sarcoma NOS	1

This last chart is taken from a thirty year study period at St. Jude Children's Research Hospital in Memphis, TN. A total of 34 cases of non-hematopoietic neoplasms were identified from 1971 cases (2% of total skin accessions). The study included both surgical and autopsy cases. These patients ranged in age from 1 month to 20 years (mean 9.8 years). Not surprisingly, the most common metastatic tumor is rhabdomyosarcoma, which is also the most common soft tissue sarcoma of childhood. In 53% of cases, the skin lesion was the presenting sign.

HISTOLOGICAL AND CLINICAL VARIANTS	CHARACTERIZATION
BREAST CANCER
Breast carcinoma-histiocytoid variant	Cancer 1973;31:793 Tendency to metastasize to eyelid
CHORIOCARCINOMA
Testicular choriocarcinoma metastatic to the skin: an additional case and literature review. Tinkle LL, Graham BS, Spillane TJ, Barr RJ. University of California at Irvine, USA.	Cutis 2001 Feb;67(2):117-20 Abstract quote Choriocarcinoma, a malignancy of trophoblastic cells, is characterized by the secretion of human chorionic gonadotropin (hCG). Choriocarcinoma primarily arises from the fetal (placental) trophoblasts in the setting of a molar pregnancy. Nongestational choriocarcinoma from the ovary or testis is much rarer. Testicular choriocarcinoma is a malignant tumor with great propensity for distant metastasis. The primary sites of metastasis are the lungs, liver, and brain. Skin metastasis is very rare but portends a grave prognosis when diagnosed. We present the case of a 24-year-old white male with a testicular mixed germ-cell tumor with skin metastases of choriocarcinoma.
ESOPHAGEAL CANCER
Metastatic adenocarcinoma of the esophagus to the skin: new patterns of tumor recurrence and alternate treatments for palliation Kathleen J. Smith1, John Williams1 and Henry Skelton2 1 Departments of Dermatology and Pathology, National Naval Medical Center, Bethesda, Maryland, USA, 2 Department of Pathology, University of Alabama, Birmingham, Alabama, USA	Journal of Cutaneous Pathology 2001; 28 (8), 425-431 Abstract quote Background: Esophageal cancer, particularly adenocarcinoma of the esophagus (ACE), has been steadily increasing in incidence in the United States. In the past, patients usually died rapidly with locoregional disease that leads to inanition and aspiration. However, today when patients with ACE are treated successfully with induction chemotherapy and radiation therapy, followed by surgical excision, ACE usually does not recur locally, but presents with metatastic disease. We present a 62-year-old white male with ACE, which was treated with induction chemotherapy and radiation therapy followed by surgical excision. After approximately 1 year with no evidence of locoregional recurrence, the patient presented with diffuse cutaneous metastatic disease. Methods: In addition to routine staining immunohistochemical stains for CK(AE1/AE3), CK7, CK 20, EMA, a-smooth muscle (SM) actin, S-100 protein, CD34, P53, Bcl-2, c-erbB-2 were performed. Results: The immunohistochemical profile was consistent with an esophageal origin showing positive staining with CK20 and CK7 as well as AE1/AE3 and EMA. In addition, there was marked nuclear expression of p53, as well as membrane expression of c-erb-B2; consistent with progression of the disease and poor response to further cytotoxic therapeutic regimes. Conclusions: With new therapeutic protocols, we can expect to see more metastatic disease with recurrences of ACE. The histopathologic features and the immunohistochemical profile of the recurrent tumors may be helpful in determining alternate forms of therapy that either alone or in combination could be useful in palliation and delaying progression.
GLIOBLASTOMA MULTIFORME
Cutaneous metastasis from an intracranial glioblastoma multiforme Patricio Figueroa, MD Jason R. Lupton, MD Todd Remington, MD Michael Olding, MD Robert V. Jones, MD Laligam N. Sekhar, MD Virginia I. Sulica, MD Washington, DC, and Fairfax, Virginia	J Am Acad Dermatol 2002;46:297-300 Abstract quote A 34-year-old white man with a history of an intracranial glioblastoma multiforme was treated with surgical excision and radiotherapy. Five months later, the patient had a rapidly growing scalp mass develop. This lesion was excised, and the histology revealed a tumor that was similar to the originally resected intracranial glioblastoma. Immunohistochemistry for general neuroepithelial derivation (S-100 protein) and for glial fibrillary acidic protein (GFAP) was positive, whereas mesenchymal, epithelial, and neuronal markers were negative. This immunohistochemistry pattern was identical to the original tumor. Although metastasis of this tumor is not uncommon, metastasis to the skin has never been reported. To our knowledge, this is the first reported case of cutaneous metastasis from glioblastoma in the world literature.

Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.

Skin

Last Updated 2/15/2002