Cutaneous Metastatic Cancer: Carcinoma Hemorrhagiectoides Presenting as the Shield Sign.

Philip R Cohen,Razelle Kurzrock

doi:10.7759/cureus.12627

Abstract

Cutaneous metastases can be either the initial presentation of an unsuspected internal neoplasm in a cancer-free individual, or the harbinger of recurrent malignancy in an oncology patient who had achieved remission of his cancer, or a sign of progressive disease in a cancer patient who is currently receiving antineoplastic treatment. The cutaneous presentation of skin metastases is pleomorphic and can mimic not only benign conditions and tumors of the skin but also infections and inflammation of the skin. Carcinoma erysipelatoides, carcinoma hemorrhagiectoides, and carcinoma telangiectoides are the three subtypes of inflammatory cutaneous metastatic cancer. The former masquerades as a cutaneous streptococcal infection whereas the latter mimics idiopathic telangiectasias. In contrast, the morphology of carcinoma hemorrhagiectoides is distinctive: it appears similar in shape to a medieval knight’s shield and its presence is referred to as a positive shield sign. To the best of our knowledge, carcinoma hemorrhagiectoides has been reported in four oncology patients whose skin metastases presented with the shield sign: two men with salivary duct carcinoma and two women with breast cancer. In conclusion, the shield sign may not only be a pathognomonic clinical feature of carcinoma hemorrhagiectoides but also reflect a common genomic aberration of these metastatic tumors.

Highlights

In 2017, a 90-year-old woman with invasive ductal breast carcinoma was reported whose cutaneous metastases presented as carcinoma hemorrhagiectoides
In 2020, an 81-year-old woman with breast adenocarcinoma developed cutaneous metastases on the chest, abdomen, flank, and back that presented as carcinoma hemorrhagiectoides
Carcinoma hemorrhagiectoides has only been observed in breast cancer patients with metastatic adenocarcinoma or invasive ductal carcinoma, as well as in oncology patients with metastatic salivary duct carcinoma

Summary

Introduction

In 2017, a 90-year-old woman with invasive ductal breast carcinoma was reported whose cutaneous metastases presented as carcinoma hemorrhagiectoides Her metastatic breast cancer skin lesions appeared as a well-circumscribed, indurated, and infiltrated plaque involving the left breast, ipsilateral chest wall, shoulder, arm, and scapular region with spread beyond the midline toward the right breast; the plaque was erythematous and had areas that were more violaceous. In 2020, an 81-year-old woman with breast adenocarcinoma developed cutaneous metastases on the chest, abdomen, flank, and back that presented as carcinoma hemorrhagiectoides Her purpuric grouped skin lesions appeared on a background of violaceous erythema; they were firm papules, nodules, and pseudovesicles. The 81-year-old woman elected to continue receiving homeopathic anticancer shakes and was lost to follow-up, whereas the 90-year-old woman’s neoplastic disease was not treated and she died within one and a half months after diagnosis [10,11]

Conclusions

Disclosures

Cohen PR