Cutaneous metastasis from squamous cell carcinoma of the cervix

Cutaneous Metastasis in a Treated Case of Cervical Cancer With Extraordinary Response to Chemotherapy: A Case Report of a Rare Event and Review of the Literature

Cervical cancer usually metastasizes to the lung, liver, bone, and brain. Metastasis to the skin from cervical cancer is relatively uncommon. The management options are systemic therapy, palliative radiotherapy, or best supportive care. Here, we report the case of a female patient with cervical cancer, stage IIB, who received radical treatment with radiotherapy and chemotherapy and later presented with disseminated skin nodules. She was treated with combination chemotherapy (nano-dispersible paclitaxel and carboplatin), bevacizumab, and a bone-stabilizing agent (zoledronic acid). There was a complete metabolic response to the therapy. There was also a dramatic improvement in the general condition of the patient. Skin metastasis in cervical cancer often presents as non-tender skin nodules. A biopsy is mandatory to establish the diagnosis. There are no specific guidelines about management. The intention of management is palliative. The combination of chemotherapy and bevacizumab produces substantial clinical improvement.

Intestinal lymphangitis carcinomatosa related to ovarian cancer: Case report and review of the literature

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Lymphangitis carcinomatosa is known as commitment of pulmonary lymph vessels.

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Intestinal lymphangitis carcinomatosa is rarely reported.

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This is the first report of intestinal lymphangitis related to ovary cancer.

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This is the first report of intestinal lymphangitis other than duodenal.

We present a 57-year-old woman with ovarian cancer that presented to the Emergency Room with a proximal small bowel obstruction. Exploratory laparotomy evidenced a thickened 10 cm extension of the proximal jejunum without bowel peristalsis, with stenotic enteric lumen, with a lesion apparently originating from its submucosal and muscular layers. The patient underwent an exploratory laparotomy with total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, small bowel resection and peritoneal biopsies. Final pathology and immunohistochemistry confirmed the intra-operative suspicion of lymphatic intestinal spread of malignant cells originating from a high grade serous carcinoma of ovarian origin. To the best of our knowledge, this is the first report in the literature of intestinal carcinomatous lymphangitis related to ovarian cancer, and the first report of involvement of the proximal portion of the jejunum.

Multiple recurrences from cervical cancer presenting as skin metastasis of different morphologies

Skin metastasis is an infrequent manifestation in oncology, with reported incidence of about 1.3% in cervical cancer. When present, it usually signals advanced disease with very limited, mostly palliative treatment options. Here we present a patient who was diagnosed with cervical cancer at an early stage and later recurred twice with skin lesions of different morphologies.

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Biopsy should be considered for skin lesions in patients with cervical cancer

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Skin metastasis may be the presenting symptom in cervical cancer recurrence

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No specific morphology is pathognomonic of cutaneous spread of cervical cancer

Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report

A 43-year-old woman treated with radical hysterectomy 1 year ago for cervical cancer presented with a suprapubic abdominal mass. A 15 cm necrotic mass from the abdominal wall along with 2 small bowel loops and the dome of the bladder were resected. The peritoneal defect was reconstructed with a pedicled anterolateral thigh and Vastus Lateralis muscle composite flap. Pathology showed invasive non-keratinizing moderately differentiated squamous cell carcinoma, consistent with metastatic cervical cancer, involving urinary bladder, bowel and soft tissue. With advancement in reconstructive surgery, extensive resection with defect closure in properly selected cases of metastatic cervical cancer to the abdominal wall may be considered in an attempt at improving quality of life and overall survival.

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Abdominal wall metastasis from cervical cancer is treated with chemo-radiation.

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Plastic reconstruction offers a surgical approach with improvement of overall survival.

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No recommendations can be made so far because of the extreme rarity of this condition.

Cutaneous Metastases: A Review and Diagnostic Approach to Tumors of Unknown Origin

CONTEXT.—

Cutaneous metastases from a distant malignancy are a diagnostic challenge for pathologists. Secondary involvement of the skin by a metastatic process portends a much worse clinical prognosis than any primary cutaneous malignant mimickers. Immunohistochemical staining methods continue to evolve and are of paramount importance in diagnosis.

OBJECTIVE.—

To review the clinical, histopathologic, and immunohistochemical staining patterns for commonly encountered entities and discuss potential pitfalls in diagnosis. A practical guide useful in approaching cutaneous metastases of unknown primary is outlined.

DATA SOURCES.—

An extensive search and review of literature in PubMed was performed, processed, and condensed.

CONCLUSIONS.—

Cutaneous metastases have broad histopathologic patterns. They are nearly always dermal based, with an overall foreign appearance. They can be single papules/nodules or multiple in number, mimicking an inflammatory or infectious process. Ultimately, immunohistochemistry remains an essential diagnostic tool, and clinical correlation is paramount in the workup of these entities.

Cutaneous lymphangitic carcinomatosis: A rare metastasis from cervical cancer

Skin metastases are a rare event in patients with cervical cancer. One form of such metastasis is carcinomatous lymphangitis, which is a rare presentation of skin metastases. Here we report a woman with cervical cancer diagnosed cutaneous lymphangitic carcinomatosis.

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Cervical cancer is the most common gynecologic malignancy in developing countries

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Skin metastasis of cervical cancer is a rare entity, more often seen with adenocarcinoma

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The management of skin metastases in patients with cervical cancer depends on the mode of presentation

Progression from Nodular to Lymphangitic Subcutaneous Metastasis from Clear Cell Endometrial Carcinoma: Ct Findings

Subcutaneous metastases from clear cell endometrial carcinoma are an uncommon event and tumor implantations are rarely found with diagnostic imaging techniques. The nodular form is the most frequent type of subcutaneous metastasis from genital system tumors, even though plaque-like and infiltrative forms have also been reported. We report the first case of subcutaneous metastasis from clear cell endometrial carcinoma whose progression from the early nodular to the lymphangitic infiltrative form was studied with computed tomography (CT). Differential diagnostic problems are discussed.

Skin metastases of cervical cancer: two case reports and review of the literature

BACKGROUND

Although cervix carcinoma is one of the most common malignancies in women, hematogenous metastases are relatively not common. Cutaneous metastases, in particular, are unusual even at an advanced stage of disease. Their presence is a predictor of poor prognosis.

CASE PRESENTATION

Case 1: A 63-year-old postmenopausal Moroccan woman was diagnosed as having cervical squamous cell carcinoma. She was treated with radical concurrent chemotherapy and radiation therapy followed by low-dose brachytherapy. Six months after finishing the therapy, multiple skin nodules appeared on her abdomen and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. Her disease progressed and she died before completing her fourth course of palliative chemotherapy. Case 2: A 48-year-old Moroccan woman was diagnosed as having cervical squamous cell carcinoma; she was treated with concurrent chemoradiation. Before a planned high-dose brachytherapy, she noticed many nodular lesions on her arms, thighs, and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. She then underwent a series of imaging examinations, including computed tomography of her chest, abdomen, and pelvis, and a whole body bone scan that showed disseminated disease involving her lungs and bones. She died after two courses of palliative chemotherapy, 2 months after the appearance of the skin lesions.

CONCLUSION

We report two cases to illustrate a rare localization of metastasis from cervical carcinoma that is highly aggressive requiring early detection and aggressive management.

Oral metastases from carcinoma of cervix

Metastatic tumours of the oral cavity are uncommon, they may occur in soft tissue as well as in bone in the oropharyngeal region. Owing to its rarity, metastatic tumours of the oral regions are a challenge to diagnose. We report a case of metastasis of the oral cavity, arising from uterine cervix mimicking as mucoepidermoid carcinoma. The metastatic lesions were noticed in the soft tissue of the lower buccal and gingival side of a oral cavity, in a 40-year-old woman with history of an adenosquamous carcinoma of uterine cervix treated by panhysterectomy.

Cutaneous metastasis in cancer of the uterine cervix: A case report and review of the literature

Carcinoma of the uterine cervix is a common neoplasm among Indian women; in fact, it is the commonest malignancy among rural Indian women. Uterine cervical cancer spreads mainly to the regional lymph nodes, with distant metastasis rarely occurring. Major sites of distant metastasis are lung, bone, and liver. Skin metastasis from carcinoma of the uterine cervix is a very rare event. The reported incidence ranges from 0.1 to 2%. Here we describe a 60-year-old woman with cervical cancer who developed metastatic lesions on the lower abdominal wall and also over the inner aspects of thigh.

Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review

Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.

Cutaneous metastases from internal malignancies

Cutaneous metastases of internal malignancies still seem to occur infrequently, although medical publications report an incidence rate of up to 10.4%. Common sense, however, fosters suspicion that we might underdiagnose the problem distracted by harder striking facets of an advanced disease. With contemporary knowledge, morphology and behavior of cutaneous metastases resemble each other regardless of the site of origin. This article itemizes clinical presentations according to organ systems, specific features, and differential diagnoses. In general, the survival turned out to be less than 12 months. But incremental awareness of cutaneous metastases proclaims this paradigm insufficient. Although excision is the local treatment of choice, investigations attempt to propose tumor-specific chemotherapeutic/immunological approaches. This paper endeavors to critically review the state of the art concerning the clinic, prognosis, and therapeutic concepts.

Cutaneous metastatic disease in cervical cancer: a case report

BACKGROUND

Cervical cancer metastasizes to skin in < 2% of patients. Cutaneous metastases can be confused with dermatitis. Their presence signals a poor prognosis.

CASE

A 66-year-old postmenopausal woman with a diagnosis of stage IVa cervical carcinoma was treated with radical concurrent chemotherapy and radiation. Two months after completing treatment, the patient noted maculopapular skin lesions in the lower abdomen. These were confirmed on biopsy as metastases from the cervical cancer. The cutaneous metastases progressed rapidly to involve the inguinal regions, vulva, and perineum. Further assessment ruled out metastases to other organs. Despite six courses of palliative combination chemotherapy, the patient's disease progressed, and she died six months after the appearance of the cutaneous metastases.

CONCLUSION

We reviewed the details of 47 reported cases of cutaneous metastases of cervical carcinoma. In the majority of these cases, patients presented within 10 years of initial diagnosis and died within a mean of 8.5 months from cutaneous metastasis.

Skin metastasis: a pathologist's perspective

Skin metastasis is defined as the spread of malignant cells from a primary malignancy to the skin. It is one manifestation of systemic spread of cancer. The tumor cells originate either from an internal malignancy or from a primary skin cancer. This study presents a literature review concerning these issues as well as this author's experience encountered throughout 19 years of surgical pathology and dermatopathology practice. Several conclusions are evident. Generally, skin metastases are encountered in 0.7-9% of all patients with cancer and as such the skin is an uncommon site of metastatic disease when compared to other organs. There is usually a long-time lag between the diagnosis of the primary malignancy and the recognition of the skin metastases. However, these metastases may be the first indication of the clinically silent visceral malignancies. The regional distribution of the skin metastasis, although not always predictable, is related to the location of the primary malignancy and the mechanism of metastatic spread. The relative frequency of skin metastasis correlates with the type of primary cancer, which occurs in each sex. For instance, lung and breast carcinomas are the most common primaries that send skin metastasis in men and women, respectively. The head and neck region and the anterior chest are the areas of greatest predilection in men. The anterior chest wall and the abdomen are the most commonly involved sites in women. Skin metastases usually appear as non-specific groups of discrete firm painless nodules that emerge rapidly without any explanation. They vary in size from so tiny as to be of 'miliary lesions' to as large as 'Hen's egg size'. Some skin metastasis may mimic specific dermatological conditions such as cutaneous cyst, dermatofibroma, pyogenic granuloma, hemangioma, papular eruptions, herpes zoster eruptions, rapidly infiltrating plaques, alopecic patches, cellulitis and erysipelas. Histologically, the skin metastases usually show features reminiscent of the primary malignancy, but with variable degrees of differentiation. Molecularly, skin metastasis is an organized, non-random and organ-selective process orchestrated by interaction among several heterogeneous molecules, which are largely unknown. Metastasis to the skin is often a pre-terminal event that heralds poor outcome.

Metastasis of carcinoma of the uterine cervix to the nasal dorsum

The nose is the most common site for cutaneous malignancies, and metastatic lesions in the skin of the nose are very rare, particularly metastasis of carcinoma of the uterine cervix. We present the fourth patient with carcinoma of the uterine cervix who had cutaneous metastasis to the nose, indicating the dissemination of her carcinoma. The patient had a diagnosis of carcinoma of the uterine cervix labeled as International Federation of Gynecology and Obstetrics stage IIB 30 months ago. She was treated with pelvic chemoradiotherapy. Multiple metastases in both of the lungs were detected by computed tomography of the thorax 1 month ago. In addition, a week later, a lesion on her nose started to appear. With an external nasal incision, the mass was excised with tumor-free borders including a skin island. Unfortunately, the patient died on the eighth postoperative day. This patient showed a very poor prognosis after the appearance of a cutaneous metastasis of the cervical carcinoma, which is often perceived as a preterminal event, generally occurring in the later stages of the illness. The treatment of these conditions is palliative and should ameliorate the mood of the patient.

Tumor invasion of the skin

This article discusses several solid organ and hematologic neoplasms that can metastasize to the skin. Special emphasis is placed on the most frequent solid and hematological malignancies that have cutaneous metastases, including breast cancer, melanoma, lung cancer, colon cancer, and leukemia. In addition, mammary and extramammary Paget's disease are further discussed as examples of direct extension of primary tumors to the skin.

Cellulitis-like cutaneous metastasis of uterine cervical carcinoma

Metastasis to the skin from cervical carcinoma is relatively uncommon. Herein we present a 41-year-old woman with a history of cervical carcinoma with severe facial erythematous swelling and telangiectasia. She was initially treated for cellulitis without improvement. A skin biopsy specimen revealed widespread intravascular tumor emboli in the dermis and subcutis, resembling the so-called inflammatory carcinoma of the breast. As this is an unusual clinical presentation for the metastasis of cervical carcinoma, this case is reported.

Cervical cancer metastasis to the scalp presenting as alopecia neoplastica

A 45-year-old Japanese woman was diagnosed in 1996 with squamous cell cancer of the cervix following an abnormal Papanicolaou smear and subsequent diagnostic conization. She underwent total abdominal hysterectomy with pelvic lymphadenectomy and was found to have poorly differentiated squamous cell carcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage IB1. She remained asymptomatic until 2003 when she presented with obstructive uropathy with acute renal failure and hydronephrosis, suspected to be from the recurrence of cervical cancer. This was confirmed when computerized tomography (CT)-guided lymph node biopsy showed squamous cell carcinoma of the para-aortic lymph nodes histologically consistent with the cervical primary. In addition, there was evidence of lumbar spine metastasis by positron emission tomography (PET) and bone scans. She received several courses of chemotherapy with cisplatin and 5-fluorouracil (5FU), as well as radiation therapy. In July 2004, she was hospitalized for acute renal failure, nausea, vomiting, and anorexia. CT of the abdomen identified widespread metastases in the liver, pancreatic head, and lumbar spine. During this hospitalization, she complained of severe scalp tenderness and patchy hair loss first noticed 3 days prior to presentation. On examination of her scalp, two patches of alopecia were observed (Fig. 1). In the largest patch, there was a 5 x 2.5-cm, tender, erythematous plaque with atrophy. In the smaller patch, there was a 2 x 1.5-cm, erythematous, scaly plaque. A punch biopsy of the larger patch revealed atypical epithelial cells in nests with intravascular involvement and diminished numbers of focally miniaturized hair follicles (Fig. 2a). The scalp specimen was histologically identical with biopsy specimens of the cervical primary (Fig. 2b). There was also seborrheic dermatitis, with thick greasy scale, noted on the scalp, which resolved with fluocinolone solution. The patient decided against further treatment for her advanced cervical cancer but did accept hydromorphone for pain. She died 3 months after admission.

Cutaneous metastasis to the scalp from squamous cell carcinoma of the cervix

Carcinoma of the cervix is a common neoplasm. Early detection and improved treatment techniques have resulted in better control of cancer and longer survival, however, invasive and metastatic disease still occur. Cervical cancer usually spreads through direct local extension and via the lymphatics, haematogenous metastasis is relatively infrequent and cutaneous metastases are very rare. Metastasis to the scalp is extremely rare and only three cases of scalp metastasis from cervical cancer have been reported in the literature. We now report a patient with cervical cancer who presented with metastasis to this very unusual site.

Skin relapse from cervical cancer

BACKGROUND

Cutaneous lymphangitis carcinomatosis from cervical carcinoma is a very rare form of tumor metastatization; only anecdotal cases are reported in the literature. Most of the patients with skin relapse experienced metastasis as a single or multiple nodules.

CASE

A case of cutaneous lymphangitis carcinomatosis mimicking contact dermatitis was diagnosed at our institution in a patient affected by cervical carcinoma stage IIB. Palliative chemotherapy with paclitaxel was started and the patient experienced complete clinical response. The hypothetical mechanism of spread and the unusual manifestation of relapse are described.

CONCLUSION

In a woman with a history of cervical cancer, a diffuse pruritic skin eruption should alert the clinician to the possibility of cutaneous carcinomatous lymphangitis. If a lymphangitis carcinomatosis is diagnosed, systemic intravenous chemotherapy should be considered.

Cutaneous metastasis from carcinoma of the cervix at the drain site

BACKGROUND

Metastasis to the skin occurs rarely in gynecologic cancer, especially in cervical carcinoma. Although carcinoma of the cervix is the second to the fourth most common malignancy in women, cutaneous involvement originating from cervical cancer is particularly unusual, even in the terminal stage of the disease.

CASE

We present a case of cervical cancer recurrence with skin metastasis. The extensive skin lesion on the abdominal wall occurred 4 years after radical surgery and postoperative radiotherapy. This was a biopsy-proven metastasis from the patient's primary cervical carcinoma.

CONCLUSION

As far we know this is the second case (after Copas et al., Gynecol Oncol 1995;56:102-4) of skin and subcutaneous tissues metastasis from cervical carcinoma at the drain site. Palliative chemotherapy and radiotherapy have a useful role in controlling symptoms.

Squamous cell carcinoma of the cervix metastatic to the skin

Carcinoma of the cervix is a common neoplasm, which annually affects 50,000 women in the United States. When cervical carcinoma metastasizes, it most often involves the lung, bone, and liver; only rarely does it metastasize to the skin. We describe a patient with previously diagnosed carcinoma of the cervix who presented with a lesion on the lateral aspect of her left leg.

Scalp metastasis from squamous cell carcinoma of the cervix

We describe a 45-year-old woman with squamous cell carcinoma of the cervix stage IIB, who was initially treated with radical radiotherapy. The patient developed multiple scalp metastases 8 months following her treatment. The scalp was involved in the disease as the sole anatomic site of distant cutaneous metastasis. The scalp lesions were treated with palliative radiotherapy. A search of the literature revealed only two cases of such distant metastatic involvement of the scalp from cervical cancer.

Extensive subcutaneous metastases from squamous cell carcinoma of the cervix in patient with HIV

Advanced human immunodeficiency viral disease is associated with a high prevalence of cervical squamous intraepithelial and invasive lesions and probably with a rapidly progressive course of disease. Metastases to the skin occur rarely in cervical cancer, even in terminal stage of the disease. A patient with human immunodeficiency virus (HIV) for 14 years was diagnosed with squamous cell cancer of the cervix, Stage I-B2 in June 1997. She underwent successful radiotherapy. She then presented in January 1999 with recurrence evidenced by extensive subcutaneous nodules and multiple metastases. The patient developed rapidly progressive disease and died within two months. Patients with HIV and cervical cancer may present with a more aggressive course of disease. Aggressive treatment and closer follow-up may be indicated.

Hematogenous skin metastases from cervical cancer at primary presentation

OBJECTIVE

Cutaneous metastasis from carcinoma of the uterine cervix is an uncommon occurrence. The majority of cases are diagnosed as recurrent carcinoma. This is believed to be the first report of hematogenous skin metastases present at the diagnosis of cervical carcinoma.

METHODS

A case of a patient with cutaneous manifestations at the time of cervical carcinoma diagnosis is presented.

RESULTS

Two lesions on the patient's hand occurred at points of recent skin puncture. These were biopsy-proven metastases from her primary cervical carcinoma.

CONCLUSION

Skin metastases from cervical carcinoma are rare and represent a poor prognostic sign.

Port-site metastasis following laparoscopic lymphadenectomy for adenosquamous carcinoma of the cervix

Although incisional metastases following surgery for cervical cancer are extremely rare, port-site disease following minimal-access surgery is becoming increasingly reported. We report a case of a metastasis which occurred at a port site following laparoscopic removal of lymph nodes affected by cervical adenosquamous carcinoma. This report adds to the literature suggesting that cutaneous tumor deposition may be enhanced by this method of surgery.

Cutaneous metastatic disease

The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.

Inflammatory cutaneous metastases from cloacogenic carcinoma of the anus

BACKGROUND

There are a few tumors that exhibit inflammatory cutaneous metastases. This pattern is particularly difficult to diagnose since it can mimic erysipelas or lymphangitis.

OBJECTIVE

This is a presentation of a 69-year-old woman diagnosed with poorly differentiated cloacogenic carcinoma who simultaneously was noted to have an abdominal rash. A biopsy confirmed cutaneous metastasis of her carcinoma.

METHODS

Previously published literature on cutaneous metastases were reviewed and summarized.

RESULTS

This is the first reported case of an inflammatory cutaneous metastasis arising from cloacogenic carcinoma.

CONCLUSION

Cutaneous metastases can present in various forms, including the inflammatory pattern. Because this form mimics other conditions, it is prudent to biopsy any suspicious skin lesion in cancer patients, as it may considerably affect prognosis.

Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients

BACKGROUND

Most previous studies have found that cutaneous metastases occur infrequently and are rarely present at the time the cancer is initially diagnosed.

OBJECTIVE

We studied patients with metastatic cancer to determine the overall frequency of skin metastases, the frequency that these were the first sign of extranodal disease, and the clinical and histologic features of the cutaneous lesions.

METHODS

A 10-year period of tumor registry files was searched for patients with metastatic carcinoma and melanoma. For patients with skin metastases, medical records and pathology reports were also examined.

RESULTS

Of 4020 patients with metastatic disease, 420 (10%) had cutaneous metastases; in 306 of them the skin metastases were the first sign of extranodal metastatic Breast cancer and melanoma were the most common. Nodules were the most frequent clinical presentation, although inflammatory, cicatricial, and bullous lesions were also noted. Incisional metastases were common. Histologic findings most frequently revealed adenocarcinoma that was sometimes suggestive of the site of origin. After recognition of skin metastases, mean patient survival ranged from 1 to 34 months depending on tumor type.

CONCLUSION

Cutaneous metastases are not uncommon and frequently are the first sign of extranodal metastatic disease, particularly in patients with melanoma, breast cancer, or mucosal cancers of the head and neck.