Cutaneous Metastasis from Colorectal Cancer: Making Light on an Unusual and Misdiagnosed Event.

Paola Parente,Stefania Caramaschi,Gerardo Cazzato,Luca Reggiani Bonetti,Diego Urbano,Giuseppe Di Maggio,Vito Attino,Vincenzo Famiglietti,Giuseppe Ingravallo,Davide Ciardiello

doi:10.3390/life11090954

Abstract

Cutaneous metastasis from solid tumors is a rare event and usually represents a late occurrence in the natural history of an advanced visceral malignancy. Rarely, cutaneous metastasis has been described in colorectal cancer patients. The most frequent cutaneous site of colorectal metastasis is the surgical scar in the abdomen following the removal of the primary malignancy, followed by the extremities, perineum, head, neck, and penis. Metastases to the thigh and back of the trunk are anecdotical. Dermatological diagnosis of cutaneous metastasis can be quite complex, especially in unusual sites, such as in the facial skin or thorax and in cases of single cutaneous lesions since metastasis from colorectal cancer is not usually the first clinical hypothesis, leading to misdiagnosis. To date, due to the rarity of cutaneous metastasis from colorectal cancer, little evidence, most of which is based on case reports and very small case series, is currently available. Therefore, a better understanding of the clinic-pathological characteristics of this unusual metastatic site represents an unmet clinical need. We present a large series of 29 cutaneous metastases from colorectal cancer with particular concerns regarding anatomic localization and the time of onset with respect to primitive colorectal cancer and visceral metastases.

Highlights

Cutaneous metastasis from solid tumors is rare and occurs in 0.7% to 5% of all cancers [1]
The most frequent cutaneous site of Colorectal cancer (CRC) metastasis is the surgical scar in the abdomen resulting from the removal of the primary malignancy, followed by the extremities, perineum, head, neck, and penis
The following data were collected: demographic data, anatomic localization, number and gross findings of the lesions, clinical hypothesis of the entity, time of onset with respect to CRC diagnosis, time of onset with respect to visceral metastases, histotype according to World Health Organization (WHO)

Summary

Introduction

Cutaneous metastasis from solid tumors is rare and occurs in 0.7% to 5% of all cancers [1]. Cutaneous metastasis generally represents a late event of an advanced visceral malignancy and occurs with greater frequency in melanoma and lung carcinoma, followed by kidney and ovary cancer [1,2]. Colorectal cancer (CRC) typically metastasizes to the lymph nodes, lung, liver, and peritoneum, and the development of skin metastasis from CRC is uncommon The literature reports two distinct clinical patterns of skin metastases from CRC: the first showing multiple visceral and cutaneous metastases at the time of presentation and the second developing cutaneous metastases during the follow-up, after the resection of the primary tumor [6]. We have retrospectively analyzed a large series of 29 cutaneous metastases from CRC and their epidemiological and clinical features with particular concerns regarding anatomic localization and the time of onset with respect to the primitive CRC and visceral metastases

Materials and Methods

Findings

Histopathological Findings

Discussion

Conclusions