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Curtis KL, Lipner SR. Metastases to the nail unit and distal phalanx: a systematic review. Arch Dermatol Res 2023; 315:347-358. [PMID: 36260150 DOI: 10.1007/s00403-022-02411-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022]
Abstract
Metastases to the nail unit/distal phalanx (NU/DP), although rare, carry a poor prognosis and are frequently misdiagnosed due to variable clinical presentation. Metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy. Since the most recent systematic review of case reports (133 patients total) was conducted in 2001, we conducted a systematic review from 1900 to 2021 (244 patients total) to assess any changes in trends in demographics, clinical presentation, and morphology and to report on more updated differential diagnoses. We also examined cases for age, sex, race, ethnicity, Fitzpatrick skin type, laterality, distribution, and diagnostic methods. The PubMed database (1900-2021) was used to detect case-level data per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that the most common primary tumors were lung, kidney, and esophagus. A NU/DP metastasis was the presenting sign of malignancy in 31.00% of patients without a former cancer diagnosis. Male to female ratio was 2:1, with average age at diagnosis 58 years. Metastases most often affected a single digit (79.91%), particularly the thumb, followed by the fourth digit. This systematic review corroborates that metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy and provides updated diagnostic guidelines. NU/DP metastasis should be considered in both healthy patients and patients with a former malignancy diagnosis presenting with nail changes involving a single digit. Prompt diagnosis and treatment may improve prognosis.
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Affiliation(s)
- Kaya L Curtis
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Shari R Lipner
- Weill Cornell Dermatology, 1305 York Avenue, New York, NY, 10021, USA.
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2
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Katsumata F, Kamiya K, Okada H, Maekawa T, Komine M, Ohtsuki M. A case of finger metastasis from esophageal basaloid squamous cell carcinoma. Int J Dermatol 2021; 61:e302-e304. [PMID: 34813081 DOI: 10.1111/ijd.16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Hirofumi Okada
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Acrometastases to the Hand: A Systematic Review. MEDICINA-LITHUANIA 2021; 57:medicina57090950. [PMID: 34577873 PMCID: PMC8471162 DOI: 10.3390/medicina57090950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. Material and Methods: A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. Results: In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10–91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5–39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7–156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Conclusions: Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.
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Endo F, Akiyama Y, Onishi M, Uesugi N, Sugai T, Sasaki A. Cutaneous metastasis from esophageal basaloid squamous cell carcinoma: A case report. Int J Surg Case Rep 2021; 80:105621. [PMID: 33596520 PMCID: PMC7893449 DOI: 10.1016/j.ijscr.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/09/2022] Open
Abstract
Cutaneous metastasis of esophageal cancer is rare. Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma. We reported a case of cutaneous metastasis from esophageal BSCC and was successfully treated with multidisciplinary treatment.
Introduction and importance Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma. Here, we reported a case of solitary cutaneous metastasis as the first symptom of esophageal BSCC and was successfully treated with multidisciplinary treatment. Case presentation A 67-year-old man visited a local hospital with symptoms of dysphagia and cutaneous nodules on his left shoulder. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed hypermetabolic accumulations in the middle thoracic esophagus, right recurrent laryngeal nerve lymph node, and epidermis of the left shoulder. Esophagogastroscopy revealed an ulcerative and infiltrating type tumor in the middle thoracic esophagus. Based on histopathologic examination of the endoscopic biopsy and the resected cutaneous tumor, the patient was diagnosed as esophageal BSCC with cutaneous metastasis. The patient was treated with chemotherapy followed by chemoradiotherapy. The therapeutic effect was a complete response, which was sustained for 39 months. Clinical discussion Review of previous literature in the PubMed database revealed only been two case reports on cutaneous metastasis of BSCC. Advanced BSCC of the esophagus with distant metastasis has a poor prognosis. Therefore, in our case, future careful follow-up is required. Conclusion Esophageal BSCC with cutaneous metastasis can be successfully managed by multidisciplinary treatment, including local resection of the cutaneous metastasis, systemic chemotherapy, and chemoradiotherapy.
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Affiliation(s)
- Fumitaka Endo
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Masazumi Onishi
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
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Puri S, Holle LM, Forouhar FA, Clement JM. Subcutaneous metastasis from recurrent basaloid squamous cell carcinoma of the esophagus. J Oncol Pharm Pract 2017; 25:492-496. [DOI: 10.1177/1078155217736920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Esophageal cancer is the 11th most common cause of cancer mortality in the United States. It is aggressive in nature and has an ability to spread rapidly through direct extension, lymphatic spread, or hematogenously. With an estimated incidence of 1%, cutaneous metastases from esophageal cancer are extremely rare. Case presentation In this case study and review, we describe a case of recurrent esophageal basaloid squamous cell carcinoma presenting as multiple, rapidly progressing and tender subcutaneous nodules. A 69-year-old male with history of basaloid squamous cell carcinoma of the esophagus treated with concurrent chemoradiation, presented to his oncologist with complaints of a large, painful nodule at the nape of his neck approximately two years after completing treatment. On further examination, he was noted to have multiple, well circumscribed, solid, tender nodules on his abdominal wall along with a painful nodule on the pulp of his index finger. Histopathology from all sites revealed skin infiltration by high-grade invasive basaloid subtype of squamous cell carcinoma, similar to patient’s prior known and treated primary esophageal cancer. Further imaging work up showed extensive metastatic disease involving lung, liver, and brain. Conclusion Esophageal squamous cell carcinoma rarely metastasize to the skin. Subcutaneous nodules can be the first presentation of recurrent disease. The lesions are commonly confused with skin infections and treated inappropriately with antibiotics, leading to delay in diagnosis of recurrent disease. Early biopsy of suspicious lesions should be performed, especially in patients with history of cancer, such that prompt diagnosis and treatment can occur to maximize patient outcomes.
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Affiliation(s)
- Sonam Puri
- Department of Hematology and Oncology, H Lee Moffitt Cancer Center/University of South Florida, Tampa, FL, USA
| | - Lisa M Holle
- Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA
| | - Faripour A Forouhar
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, CT, USA
| | - Jessica M Clement
- Department of Hematology and Oncology, UConn Health, Farmington, CT, USA
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Chen Y, Tang W, Xiao H, Chen J, Zhao H, Shi J. An isolated unusual digit metastasis from esophageal carcinoma: a case report. Onco Targets Ther 2017; 10:2449-2452. [PMID: 28533688 PMCID: PMC5431735 DOI: 10.2147/ott.s132027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Distant soft tissue tumor metastasis isolated in the digit, presenting as a primary esophageal squamous cell carcinoma is considered extremely rare. Herein, we present a rare case of a 44-year-old male patient with squamous cell carcinoma of the esophagus associated with the clinical symptoms of progressive dysphagia and hoarseness in the course of 2 days. During the second course of chemotherapy, the patient sustained a fall with scald to his right ring finger, while the swelling in the right ring finger was soft, cystic and 2.0×1.8 cm in size. Then, phalangectomy was performed in his right ring finger and pathologic diagnosis was considered metastasis from the esophagus. Unfortunately, the patient succumbed to this disease within 2 months of diagnosis of metastasis. In conclusion, detection of soft tissue metastasis may have prognostic implications, providing more accessible biopsy sites and helping avoid invasive procedures.
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Affiliation(s)
- Yi Chen
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University.,Department of Oncology, Nanjing Pukou Central Hospital
| | - Weiwei Tang
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Hua Xiao
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jinfei Chen
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Huanyu Zhao
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Junfeng Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
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7
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Joglekar S, Daneshvar S, Sinha A, Saxena P. Metastatic primary cutaneous basaloid squamous cell carcinoma: transformation after 20 years of neglect. ANZ J Surg 2015; 88:E87-E88. [PMID: 26336073 DOI: 10.1111/ans.13275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shantanu Joglekar
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Simin Daneshvar
- Department of Anatomical Pathology, Austin Hospital, Melbourne, Victoria, Australia
| | - Alka Sinha
- Department of Anatomical Pathology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
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8
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Afshar A, Farhadnia P, Khalkhali H. Metastases to the hand and wrist: an analysis of 221 cases. J Hand Surg Am 2014; 39:923-32.e17. [PMID: 24612837 DOI: 10.1016/j.jhsa.2014.01.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify demographic trends, survival rates, the most common metastatic locations, and the most common primary malignant tumors in the reports of hand and wrist metastases published over the past 27 years. METHODS A keyword search was performed across PubMed, Google, Science Direct, and Springer databases with a time-range restriction set between April 1986 and April 2013. A total of 193 articles were located describing 221 patients. The data were analyzed for patient age, sex, known history of malignancy, primary tumor site, histological diagnosis, metastatic location, hand involvement, and survival rates. RESULTS Lung, gastrointestinal tract, and kidney malignancies were the 3 leading metastatic tumors. The mean age among patients was 61 ± 13 years, and involvement among men was almost twice as common as among women. The mean survival from the time of the diagnosis was 7 ± 7 months. There were no predilections for either the right or the left hand. The distal phalanx was the most frequently involved bone, and the thumb was the most frequently involved digit. CONCLUSIONS The frequency of published hand and wrist metastasis has increased dramatically within the last decade. Metastases have been reported for every bone of the hand and wrist as well as for the soft tissues. Compared with the previous studies, the mean age of reported patients has slightly increased even though the mean survival time has not changed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
| | - Payam Farhadnia
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Hamidreza Khalkhali
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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9
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Basaloid squamous cell carcinoma of the skin. J Am Acad Dermatol 2011; 64:144-51. [DOI: 10.1016/j.jaad.2010.02.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 02/17/2010] [Accepted: 02/19/2010] [Indexed: 11/20/2022]
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10
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Iwanski GB, Block A, Keller G, Muench J, Claus S, Fiedler W, Bokemeyer C. Esophageal squamous cell carcinoma presenting with extensive skin lesions: a case report. J Med Case Rep 2008; 2:115. [PMID: 18426583 PMCID: PMC2365965 DOI: 10.1186/1752-1947-2-115] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 04/21/2008] [Indexed: 01/30/2023] Open
Abstract
Introduction Esophageal squamous cell carcinoma (ESCC) is the most common histological subtype of cancer in the upper and middle esophagus and is characterized by a high rate of mortality. The incidence of esophageal cancer varies greatly among regions of the world and occurs at a high frequency in Asia and South America. Case presentation In our department, a 51-year-old man was diagnosed with ESCC after presenting with extensive disseminated skin nodules. Biopsy of the nodules showed metastatic ESCC. Cutaneous manifestations of esophageal neoplasia are very rare and are mainly described for esophageal adenocarcinoma (EADC). Here we report a very uncommon case of extensive skin metastases of ESCC. Conclusion Early biopsies of suspicious skin lesions are important and should be performed in patients with unclear symptoms such as weight loss or dysphagia and especially in patients with a history of cancer, since they can reveal the existence of a distant malignant disease leading to diagnosis and prompt therapy.
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Affiliation(s)
- G B Iwanski
- Department of Internal Medicine, Oncology and Hematology, University Hospital Hamburg, Eppendorf, Martinistrasse, Hamburg, Germany.
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Elhassan B, Fakhouri A. Metastasis of squamous-cell carcinoma of the lung to the first web space of the hand. ACTA ACUST UNITED AC 2007; 89:1243-6. [PMID: 17905966 DOI: 10.1302/0301-620x.89b9.19186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While primary squamous-cell carcinoma of the hand is common, metastasis of a squamous-cell carcinoma to the hand is very rare. It has been reported to arise from carcinoma of the lung and oesophagus and, rarely, from other tumours. We describe a patient with metastatic squamous-cell carcinoma occurring in the first web space of the hand from primary lung cancer, which remained undetected for 30 months after treatment of the metastasis.
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Affiliation(s)
- B Elhassan
- Mayo Clinic, 200 2nd Street SW, Rochester, Minnesota 55905, USA.
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Hayden RJ, Sullivan LG, Jebson PJL. The hand in metastatic disease and acral manifestations of paraneoplastic syndromes. Hand Clin 2004; 20:335-43, vii. [PMID: 15275692 DOI: 10.1016/j.hcl.2004.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Metastatic tumors to the hand and wrist are rare, accounting for approximately 0.1% of all metastatic lesions to the skeleton. The biochemically mediated pathways of bone metastases, the location of the hand at the distal extremity, and the small amount of marrow in the bones of the hand and wrist account for the low prevalence of acrometastases. More rarely, hand dermatologic and soft tissue changes of paraneoplastic syndromes herald an occult malignancy.
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Affiliation(s)
- Radford J Hayden
- Division of Hand, Elbow, and Microsurgery, Department of Orthopaedic Surgery, University of Michigan Medical Center, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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