Page 72 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 3-7 Integumentary System

Fulminant erysipeloid
cancer from an
underlying breast
carcinoma

Inflamed skin

CUTANEOUS METASTASES

Metastasis to the skin is an uncommon presentation of
internal malignancy. Cutaneous metastases are far more
likely to be seen in a patient with a diagnosis of previ-
ously metastatic disease. The frequency of cutaneous
metastasis is dependent on the primary tumor. Almost
all types of internal malignancy have been reported
to metastasize to the skin; however, a few types of
cancers account for the bulk of cutaneous metastases.
The distribution of the metastases is also dependent on
the original tumor. The most common form of skin
metastasis is from an underlying, previously metastatic
melanoma.
Clinical Findings: Most cutaneous metastases mani- Invasion of dermal lymphatics and
fest as slowly enlarging, dermal nodules. They are lining up of tumor cells between
almost always firm and have been shown to vary in collagen bundles
coloration. Some nodules eventually develop necrosis,
ulcerate, and spontaneously bleed. Skin metastasis can
occur as a direct extension from an underlying mali-
gnancy or as a remote focus of tumor deposition. Recurrent
Although skin metastasis often arises in the vicinity of cancer
the underlying primary malignancy, the location of Carcinoma
tumor metastases is not a reliable means of predicting forming along
the primary source. The scalp is a common site, prob- surgical wound
ably because of its rich vascular flow.
Sister Mary Joseph nodule is a name given to a perium-
bilical skin metastasis from an underlying abdominal
malignancy. This is a rare presentation that was first
described by an astute nun at St. Mary’s Hospital at the
Mayo Clinic. This has been described to occur most
commonly with ovarian carcinoma, gastric carcinoma,
and colonic carcinoma.
Melanoma metastases are usually pigmented and
tend to occur in groups. Cutaneous metastasis from Colonic adenocarcinoma
melanoma can manifest with the rapid onset of multiple metastatic to the flank
black papules and macules that continue to erupt. As
the tumors progress, patients can develop a generalized
melanosis. This is a universally fatal sign that occurs
late in the course of disease. It is believed to be caused
by the systemic production of melanin with deposition
in the skin.
Breast carcinoma is another form of malignancy that
frequently metastasizes to the skin. Breast carcinoma
tends to affect the skin within the local region of the process that depends on the production of multiple adjunctive chemotherapy and radiotherapy should be
breast by direct extension. growth factors and evasion of the patient’s immune considered. Palliative surgical excision can be under-
Pathogenesis: The exact reason why some tumors system. taken for any cutaneous metastases that are painful,
metastasize to the skin is unknown. This is a complex Histology: The diagnosis of cutaneous metastasis is ulcerated, or inhibiting the patient’s ability to function.
biological process that is dependent on many variables. almost always made by the pathologist after histological The prognosis for patients with cutaneous metastasis is
Metastases are likely to be dependent on size, ability to review. Each tumor is unique, and the histological poor. The overall survival rate for multiple cutaneous
invade surrounding tissues (including blood and lym- picture depends on the primary tumor. metastases has been reported to be 3 to 6 months. The
phatic vessels), and ability to grow at distant sites far Treatment: Solitary cutaneous metastases can be length of survival is increasing now because of improved
removed from the original tumor. This is an intricate surgically excised. The risk of recurrence is high, and treatments.

58 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS