Tumour Recurrence in peristomal skin: a case report

Abstract

Peristomal skin recurrences of colorectal cancer after excision of the primary are rare. Clinically, it presents as a subcutaneous mass throughout the abdominal wall and progressively extends on the abdomen as a skin granuloma. Two colorectal cancer patients (an 83-year-old man, previously treated with left hemicolectomy and right exteriorisation for an obstructive tumour of the descending colon, Stage IV mucinous, poorly differentiated adenocarcinoma, and a 60-year-old man who finished the Hartmann's operation and small bowel resection for a perforated and locally advanced cancer of the descending colon) presented tumour recurrences in their peristomal skin. In both patients, the initial presentation was a tiny mucocutaneous skin granuloma. Subsequently, it became a large-sized, atypical, fungated tumour growth, which was complicated with persistent bleeding. A skin biopsy demonstrated an infiltration of adenocarcinoma throughout the dermis and was diagnosed as a local recurrence accompanied by peristomal skin metastasis. Although abdominal skin metastasis of colorectal cancer is rare, it is often a sign of intraabdominal recurrence. Therefore, any unusual skin lesions around the incision scar or stoma should be early biopsied to rule out local metastasis. Stoma nurse specialists play a crucial role in conducting stoma examinations, which involve both stoma and abdominal assessments. Point of care using ultrasound; clinical photos; telehealth; and patient empowerment could be advanced to facilitate early identification of stomal complications for timely investigation and treatment.