Diagnosis Of Cutaneous Metastasis Research Articles

Thyroid Cancer With Cutaneous Metastases.

Objectives: Thyroid carcinoma with cutaneous metastases is a rare clinical finding. Cutaneous metastases from thyroid carcinoma have been associated with a poor prognosis, but these data are limited to case reports. The exact mechanism of cutaneous metastases from thyroid carcinoma is not clear. Our study aims to report the demographic, clinical, and histologic findings of patients with cutaneous metastases from thyroid carcinoma. Methods: A review was conducted using the Medline/PubMed, Cochrane, and Scopus databases to review literature from inception to May 2023. Data extracted included patient age at diagnosis of cutaneous metastases, patient sex, thyroid carcinoma histotype, location of metastases, the time interval between diagnoses of thyroid carcinoma and cutaneous metastases, and overall survival (OS) from the time of cutaneous metastases. Results: One hundred thirty-six patients were identified and 75 were female. The most common types of thyroid carcinoma with cutaneous metastases were papillary (47.79%), followed by follicular (30.15%), and medullary (11.03%). In addition, 11 cases of anaplastic carcinoma, 2 cases of oncocytic carcinoma, and 2 cases of poorly differentiated thyroid carcinoma were reported. The average age at diagnosis of cutaneous metastases was 63.13 years, and the average time interval between the diagnoses of primary thyroid carcinoma and cutaneous metastases was 48.27 months. The most common location of metastases was the scalp (n = 48). Other common locations included the neck, chest, and face. The OS after diagnosis of metastases was only available in 34 patients with an average of 13.07 months. Of these 34 cases, 10 were medullary, 10 were papillary, 9 were anaplastic, and 5 had follicular carcinoma. Conclusions: This study represents an up-to-date review of the cases of thyroid carcinoma with cutaneous metastases. While cutaneous metastasis remains a rare finding, one needs a high index of suspicion, and their presence portends a poor prognosis.

Immediate diagnosis of cutaneous metastases with optical coherence tomography, line‐field confocal optical coherence tomography and dermoscopy: A case series

AbstractBackgroundCutaneous metastases (CM) are a frequent finding in the follow‐up of malignant tumours.ObjectivesCM were examined with dermoscopy, optical coherence tomography (OCT), dynamic OCT and line‐field confocal OCT (LC‐OCT) to describe common findings.MethodsIn the University Hospital Carl Gustav Carus Dresden, Germany, 18 patients with 61 CM were examined with dermoscopy. CM (n = 43, 31 melanoma metastases, two metastases of renal carcinoma, five metastases of cutaneous squamous cell carcinoma and five metastases of pleomorphic dermal sarcoma) were examined with OCT (VivoSight® Michelson Diagnostics). Additional 18 melanoma metastases were examined with LC‐OCT (deepLive™; Damae Medical).ResultsCM were localized on the head, trunk, neck and limbs. Dermoscopy patterns were angioma‐like, nevus‐like nonglobular, nevus‐like globular, blue nevus‐like and unspecific. CM showed an ulceration, hyperkeratosis with increased entrance signal and disturbed architecture of the epidermis in OCT. In deeper metastases, the dermoepidermal junction (DEJ) was normal; in most cases it was disturbed. CM were visible as subepidermal hyporeflective roundish area, with septae, with either clear margin and shadowing or blurred margin. DOCT showed dot, coiled, serpiginous and branched vessels; there was a disarray in size and distribution and vessels were converging on the centre of the metastasis. In LC‐OCT, CM showed enhanced entrance signal and disturbed architecture of a thinned epidermis, ulceration, atypical honeycomb or cobblestone pattern as well as a broken DEJ. In the dermis, a hyporeflective roundish area with clusters of hyporeflective cells with septae, clear margin and clefting or blurred margin was visible; the hyporeflective area was surrounded by bundles of connective tissue. Subepidermal vessels differentiated in size and distribution. Inflammatory, dendritic and pagetoid cells were visible.ConclusionsOCT and LC‐OCT may be useful tools for immediate diagnosis, localization of CM and monitoring under treatment in addition to conventional methods like ultrasound and histopathology.

Pancreatic cancer: Cutaneous metastases, clinical descriptors and outcomes.

615 Background: The occurrence of cutaneous metastasis from pancreatic cancer (PC) is rare, and the exact incidence is unknown. The literature to date is primarily limited to isolated case reports. Herein, we evaluate the clinical, genomic, and other descriptors of patients with PC and cutaneous metastases. Methods: Institutional databases were queried using search terms “pancreas cancer” and “cutaneous mets”. Clinical history, demographics, PC cutaneous metastasis details, and survival outcomes were abstracted. Results were described using descriptive statistics, and overall survival (OS) from the diagnosis of cutaneous metastasis was estimated using Kaplan-Meier methods. Results: Of 140 on initial search, 40 patients met inclusion criteria of PC and cutaneous metastases and were analyzed. The median age (Q1-Q3, IQR) of pancreatic cancer diagnosis was 66.0 (59.3-72.3, 12.9) years. Most common histologic subtype was adenocarcinoma (n= 39, 98%), and one patient had a neuroendocrine malignancy. Most patients had stage IV disease at diagnosis (n=26, 65%). The most common location of the primary tumor was tail of the pancreas (n=17, 43%). Forty-eight percent (n= 19) had cutaneous metastasis at/within one month of cancer diagnosis. Most patients received chemotherapy (n=37, 93%), with 14 patients (35%) patients also receiving local therapy in the form of local excision or radiation. The most common cutaneous metastasis site was the abdomen (n=40, 66%), with umbilical lesions occurring in 58% (n=23) of abdominal lesions. The median interval (Q1-Q3, IQR) between diagnosis of pancreatic cancer and development of cutaneous metastasis was 1.4 (0-14.5, 14.5) months. The median OS (95% CI) from cutaneous metastasis diagnosis was 11 months (7.0, 20). Table details the observed differences between umbilical vs. non-umbilical metastases. Sixteen of 40 (40%) patients underwent somatic testing. The most frequently mutated genes were KRAS (n= 16, 100%), TP53 (n=7, 44%), CDKN2Ap14ARF (n=5, 31%), CDKN2Ap16INK4A (n=5, 31%), and CDKN2B (n=3, 19%). Germline testing was undertaken in 12 (30%) patients, and pathogenic variants were observed in 3: CHEK2 (n=1, 8%), BRCA1 (n=1, 8%), and ATM (n= 1, 8%). Summary of cutaneous metastasis characteristics. Conclusions: Cutaneous metastases from PC are rare and can be present at the time of diagnosis of stage IV disease, occurring most frequently in the umbilicus. Cutaneous metastases can be classified into umbilical and non-umbilical metastases, which may be due to a different biology.[Table: see text]

Cutaneous metastasis of invasive ductal carcinoma on FNAC: A case report

The cutaneous metastasis is a late uncommon manifestation of cancer and indicates poor prognosis. The cutaneous metastasis can be a first presentation of underlying malignancy. The FNAC is an easy tool for rapid diagnosis of cutaneous metastasis. A 47-year-old female, known case of invasive ductal carcinoma presented to hospital with history of multiple nodular skin lesions over the body varying in size from 0.5-1.5 cm from past 2 months. The smears were cellular and comprises of loose clusters and singly scattered atypical epithelial cells, displaying moderate degree of pleomorphism with mild amount of cytoplasm, large irregular nucleus with fine to coarse chromatin, inconspicuous to conspicuous nucleoli and occasional atypical mitosis against a lipohemorrhagic background. The diagnosis of metastatic deposits of invasive ductal carcinoma was rendered. The clinical diagnosis of metastatic deposits can be challenges, especially in case of distant metastasis or when the cutaneous metastasis is the first presentation. The cutaneous metastasis can be confused clinically as adnexal lesion. The use of special stains and immunohistochemical markers can aid in diagnosis.

Clinical and morphological spectrum of cutaneous metastases on cytology: A study of 225 cases.

Any type of cutaneous metastasis indicates dismal outcome of the disease. Skin is an unusual location for metastatic deposits from any tumour and has an incidence of about 0.8%-5%. Fine needle aspiration cytology (FNAC) helps in the rapid diagnosis of metastasis with minimum pain. To study the cytomorphological spectrum of cutaneous metastasis on FNAC. A total of 225 patients withdiagnosis of cutaneous metastasis on cytology were analysed. May-Grünwald Giemsa and haematoxylin-eosin-stained smears were studied and examined for the cytomorphological spectrum of cutaneous metastasis. Cell block was prepared in a few cases. In a subset of cases, immunohistochemistry was done to pinpoint the primary. Amongst the 225 patients studied, the mean age was 53.9years. There was female preponderance with 125 females and 100 males. The commonest site was abdominal wall (n=89) followed by chest wall (n=60). The most common type of metastasising tumour was adenocarcinoma. Clinicians and pathologists must be aware of the clinico-morphological spectrum of cutaneous metastasis for instant diagnosis followed by prompt management.

Cutaneous metastases from solid neoplasms in the 21st century: a retrospective study from a Portuguese tertiary care center.

Cutaneous metastases account for 2% of all skin cancers and are usually associated with widespread disease. The main of this retrospective study was to describe and illustrate clinicopathological features of cutaneous metastases diagnosed in our centre since the beginning of this century. All cases of cutaneous metastases from solid neoplasms diagnosed in our Dermatopathology Department from January 2000 to December 2018 were included. Statistical analysis was performed with SPSS. A total of 164 patients were included, with a female to male ratio of 3:2. Malignancies that most commonly metastasized to the skin were melanoma (N=58), breast cancer (N=54) and lung cancer (N=13). Immunohistochemical study was performed in 99 patients (60.4%). Time diagnosis of the primary tumour and appearance of cutaneous metastases was significantly higher in breast cancer, followed by melanoma and then by lung cancer (P<0.05). Median survival after diagnosis of cutaneous metastases was 8months. Survival after diagnosis of cutaneous metastases was also influenced by age of the patient, both at diagnosis of the primary tumour and at diagnosis of the cutaneous metastasis. Clinical presentation of cutaneous metastases is highly variable and non-specific, being easily mistaken for other dermatological conditions. Histopathological examination is essential in this setting, and the judicious use of an immunohistochemistry panel considered the appropriate morphologic and clinical context. Survival after the diagnosis of cutaneous metastases is influenced not only by the location of the tumour but also by the age of the patient. Dermatologists should therefore be to these clinical pictures, and a high degree of suspicion is, along with a careful clinical history and physical examination. Although being limited by its retrospective nature, we describe one of the largest European series of cutaneous metastases, with findings with most of the available literature.

A Case of Widespread Cutaneous Metastases from Esophageal Adenocarcinoma

Cutaneous metastases from internal malignancies are very rare, and only a few cases from esophageal cancer have been reported. We describe the case of a 61-year-old patient with recently diagnosed esophageal adenocarcinoma who presented with multiple skin nodules. Immunohistochemical analysis of the nodules matched the immunohistochemical profile of the patient’s previous esophageal biopsy specimen confirming the diagnosis of cutaneous metastases. This case highlights the importance of including cutaneous metastases in the differential diagnosis of any suspicious lesion in patients with a history of internal malignancy.

EP1.01-87 Cutaneous Metastasis in Lung Cancer – A Retrospective Study in a Local Health Unit in Guarda, Portugal

Cutaneous metastasis from lung cancer is rare, occurring in 0.22-12% of cases. Their presence has generally been considered a sign of an already disseminated, poor-prognosis and non-surgical disease. Current data suggest lung cancer is the second most frequent cause of cutaneous metastasis in men, behind malignant melanoma. We conducted a retrospective analysis of patients diagnosed with lung cancer and cutaneous metastasis, submitted to skin biopsy to confirmation, from November 2010 to March 2019, in our local health unit. Data regarding demographic characteristics, smoking history; location and histology and of the primary tumor; staging; number, location and type of skin lesion; overall survival and survival after detection of cutaneous metastasis were collected from clinical records. Five patients were included, 4 were of male gender (80.0%), with median age of 79 years (range, 56-88). Three patients (60.0%) were former smokers, 1 current smoker and 1 non-smoker. The location of the primary tumor was right upper lobe (3 cases, 60.0%) and left lower lobe (2 cases, 40.0%); histology of adenocarcinoma in 3 patients (60.0%), 1 patient with squamous cell carcinoma and another with neuroendocrine carcinoma. All cases of lung cancer were diagnosed with an initial stage IV disease. Most of them had a unique skin lesion, mainly a nodule, located either in the upper abdominal wall or dorsal region. From the 5 cases, 4 had died, with a median overall survival 0.5 months (range, 0-1) and survival after cutaneous metastasis 15.5 days (range, 12-82). According to data, also in our study men had more cutaneous metastasis from lung cancer than women. Previous or active smoking history was present in almost all patients, the main histology type was adenocarcinoma and primary lung cancer was frequently located in right upper lobe, consistent with reported data. In all cases, lung cancer was diagnosed in an advanced stage and survival after diagnosis of cutaneous metastasis was extremely low.

Clinicopathological analysis of 50 cases of cutaneous metastasis of malignant visceral tumors

Objective To investigate clinical manifestations and histopathological features of cutaneous metastasis of malignant visceral tumors, to improve diagnosis of cutaneous metastasis of malignant visceral tumors. Methods A total of 50 patients with cutaneous metastasis of malignant visceral tumors were enrolled from Shanghai Skin Disease Hospital between January 2012 and June 2018, and the features of the skin lesions, source of tumors, histological and immunohistochemical features were retrospectively analyzed. Results There were 24 males and 26 females among the 50 patients, with an average age of 67.0 years (range, 28 - 93 years) . The average duration from the notice of cutaneous metastasis of malignant visceral tumors to the first clinic visit was 4.4 months (range, 2 weeks - 13 months) . Cutaneous metastasis of malignant visceral tumors mostly occurred on the chest (16 cases) , followed by the lower limbs (7 cases) , the head and neck (5 cases) , the back (5 cases) , the abdomen (4 cases) , the external genitalia (4 cases) and the upper limbs (3 cases) . Cutaneous metastasis of malignant visceral tumors simultaneously or successively occurred on multiple sites in 6 cases. The most common skin lesion was solitary lump (35 cases, 70%) , followed by multiple papules and nodules (13 cases, 26%) , infiltrative plaques (1 case, 2%) and non-infiltrative erythema (1 case, 2%) . The most common types of primary cancers were breast cancer (11 cases, 22%) , lung cancer (9 cases, 18%) and gastric cancer (6 cases, 12%) , and the most common histological types were adenocarcinoma (32 cases, 64%) and squamous cell carcinoma (8 cases, 16%) . Conclusions Cutaneous metastasis of malignant visceral tumors mostly occur in the elderly and on the chest. The most common skin lesion was solitary lump. Breast carcinoma, lung cancer and gastric cancer are the most common primary tumors, and adenocarcinoma and squamous cell carcinoma are the most common histological types. Key words: Neoplasm metastasis; Skin; Skin manifestations; Pathologic processes

Fine needle aspiration cytology-a boon in the diagnosis of cutaneous metastasis

Cutaneous metastasis is an uncommon manifestation of visceral malignancy (0.8-5%) indicating a grave prognosis. Cutaneous metastasis manifests as nodules, ulceration, cellulitis or fibrotic processes. Lesions are solitary or multiple frequently found near the primary tumour. The most frequent organs presenting with cutaneous metastasis are breast, skin (melanoma), lung, colon, stomach, upper aerodigestive tract, kidney and the uterus. On histopathology they can be classified as adenocarcinoma, squamous cell carcinoma, undifferentiated carcinoma and other miscellaneous types. The present series involves 3 cases of cutaneous metastasis diagnosed on FNAC. First case of osteosarcoma presenting as swelling in femoral region, second case as swelling in cervical region from cancer oesophagus and third case presented with swelling over sternum from an unknown primary. FNAC is the first line diagnostic procedure for diagnosis of cutaneous metastasis.It is inexpensive, simple and fast diagnostic tool confirming clinical diagnosis.

Fine needle aspiration cytology - a boon in the diagnosis of cutaneous metastasis

Fine needle aspiration cytology - a boon in the diagnosis of cutaneous metastasis

Mucinous Adenocarcinoma Of Colon Presenting As Cutaneous Metastases Over The Abdominal Wall: A Rare Entity On Cytology

Skin metastases from colorectal carcinoma are rare and typically signify widespread disease with poor prognosis. We present two cases of a 55years old man and a 57 years old lady, both presenting with multiple skin nodules on the abdominal wall. FNAC smears of both the cases showed clusters and sheets of atypical cells with moderate amount of cytoplasm against a necrotic background. Nuclei were round to oval with coarse chromatin and prominent nucleoli. Well formed glandular structures were seen. Immunocytochemistry showed that cells were positive for Muc-1, and negative for vimentin and LCA. A diagnosis of adenocarcinoma presenting as cutaneous metastasis was given. Detailed history, showed that both the patients were known cases of adenocarcinoma colon post chemotherapy and radiotherapy. Colorectal carcinoma presenting as cutaneous metastases is rare and FNAC is a noninvasive and fast method for directing towards the diagnosis of cutaneous metastasis in the patients with a known malignancy without any complication. DOI: 10.21276/APALM.2017.1070

English

INTRODUCTION: Cutaneous metastasis of follicular carcinoma of thyroid is rare. There are fewer than 30 cases reported in the literature, majority affecting the scalp. CASE HISTORY : 55yrs old female presented with swelling over right side of the forehead. FNAC from the nodule showed uniform sized epithelial cells arranged in repetitive follicular pattern & rosettes, suggestive of follicular carcinoma of thyroid. RESULTS: Morphological features of follicular carcinoma thyroid are unique in FNAC smears & hence we came to the diagnosis of follicular carcinoma thyroid on FNAC of forehead nodule. DISCUSSION : Cutaneous metastasis explains the aggressive nature of the disease & they have contributed to poor outcome. Average length of survival after diagnosis of cutaneous metastasis from follicular carcinoma thyroid is 19 months. CONCLUSION: We have presented an unusual case of aggressive follicular carcinoma thyroid with wide spread cutaneous metastases.

Erythematous nodules of the hand: A rare site of metastatic breast carcinoma

Acral cutaneous metastasis is a rare phenomenon. A 38-year-old woman presented with painful lesions in the left hand since 1 month. On examination, multiple painful, erythematous, lobulated plaques and nodules were present over the palmar aspect of the finger tips and thenar eminence. Biopsy of the nodule revealed lobules of small pleomorphic epithelial cells arranged in singles, small nests, cords and small abortive luminal pattern in an abundant mucoid matrix, suggestive of metastatic mucinous carcinoma. Past history revealed that the patient had undergone bilateral mastectomy for carcinoma breast. Diagnosis of cutaneous metastases is based on clinical history and histopathological examination. Identification of the primary tumor is very important for prompt treatment and prognosis. The rarity of pure acral cutaneous metastasis and its possible pathogenetic mechanisms are discussed.

Carcinoma dei Dotti Collettori del Bellini: Case Report con Metastasi Cutanea Come Iniziale Manifestazione Clinica

Bellini's collecting ducts carcinoma represents a rare tumor with an aggressive behaviour with a poor prognosis and often metastatic at diagnosis. We report the first case documented of Bellini tumor with an initial clinic presentation represented by a cutaneous metastasis of scalp. All pertinent clinical information were compiled, including patient age, sex, mode of presentation, preoperative laboratory data, radiologic findings, surgery type, macro and microscopic findings, survival data. After reporting an histopathologic finding of cutaneous metastasis of unknown origin adenocarcinoma with poorly differentiation, a voluminous 6 cm left mesorenal mass is diagnosed through uro-CT. Consequently, it is performed a left radical transperitoneal nephrectomy with consensual exeresis of scalp cutaneous lozenge at the level of previous excision. The histopathologic diagnosis reported was Bellini tumor at stage pT3a-N2-M1. It has not reported significative responsiveness to adjuvant chemotherapy and the patient was died seven months after diagnosis of cutaneous metastasis. Most of Bellini’s carcinoma are already metastatic at presentation. Analyzing literature, it is never documented a cutaneous metastasis as first sign at clinical presentation. In this context, radical nephrectomy, differently from others subtypes of advanced renal cell carcinoma, does not seem to improve survival of the patient but rather, it can keep a role in palliation or in the context of new chemotherapeutic protocols.

Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal

Cutaneous metastases are perceived as a sign of advanced disease and are regarded as a grave prognostic indicator. In addition, few reports have focused on the cutaneous metastasis profiles of Asian patients. We seek to analyse the clinical and prognostic characteristics of cutaneous tumour metastases in a Taiwanese medical centre. Clinical records from Kaohsiung Medical University Hospital over the last 20 years (1986-2006) were reviewed, and cases of biopsy-proven cutaneous metastases from internal malignancies identified. Survival rates were evaluated using the Kaplan-Meier method and compared by the log-rank test. The Cox proportional hazards model was used for univariate analysis to determine the risk of mortality among different groups. A total of 141 cases of cutaneous metastases were identified. The clinical profiles were similar to those from western countries, although the frequencies of primary tumours were different. The duration of survival was usually short following diagnosis of cutaneous metastases, but prognosis is significantly better in breast cancer patients with metastases. Moreover, the survival was even longer for breast cancer patients when the metastasis was confined to the skin. The risk of skin metastases depends largely on the characteristics of tumour cells, which is similar among different ethnic groups. In terms of prognosis, a subset of breast cancer patients has superior prognosis, even among breast cancer patients with stage IV disease. Physicians should consider this finding in clinical situations to avoid possible misinformation about the prognosis of the disease.

A Baffling Basaloid Blain

Cutaneous metastases may present in a variety of histologic guises simulating more common primary tumors. We present the clinicopathologic features of a case masquerading as basal cell carcinoma. Epidermotropism, vascular invasion, and the absence of stromal retraction around tumor nests prompted further investigation. Clinical history and directed immunohistochemical staining ultimately revealed the diagnosis of cutaneous metastasis of transitional cell bladder carcinoma (TCC).

Cutaneous Metastasis From Adenoid Cystic Carcinoma of the Parotid Gland

BACKGROUND Cutaneous metastasis from adenoid cystic carcinoma of the salivary gland is very rare. OBJECTIVE To present an unusual case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. METHODS A 63-year-old woman with multiple subcutaneous nodules on the abdomen and a gradually enlarged mass over the right parotid area was examined. A skin biopsy was taken from one of the abdominal nodules. RESULT Skin biopsy demonstrated the characteristic histopathologic features of metastatic adenoid cystic carcinoma. A subsequent computerized tomography of the head and neck revealed a huge soft tissue mass involving the right parotid gland. Computerized tomography of the chest revealed extensive nodular pleural thickening, and pleural biopsy also showed typical histopathologic features of metastatic adenoid cystic carcinoma. All of these results are consistent with the diagnosis of an adenoid cystic carcinoma of the right parotid gland with disseminated metastases. CONCLUSION We report a rare case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. The presentation of cutaneous metastasis is often nonspecific and may mimic benign lesions. Subcutaneous nodules that are rapidly developing or eruptive, are rapidly growing and have stony hardness in nature, have pain or tenderness, and have nonhealing ulceration remind us of the possibility of cutaneous metastases. Dermatologists and dermatologic surgeons should keep the diagnosis of cutaneous metastasis in mind and always perform skin biopsy when encountering these lesions.

CUTANEOUS RELAPSE OF TESTICULAR EMBRYONIC CARCINOMA

Cutaneous metastases from testicular cancer are rare and only a few cases have been reported in the literature. Of 6 cases reported to date 5 had advanced disease with metastases to lung, liver or brain at the time of diagnosis of cutaneous metastases. CASE REPORT A 30-year-old man with a testicular tumor containing components of embryonic carcinoma and seminoma had metastases to the lung and mediastinum at the time of diagnosis. He was initially treated with 4 cycles of chemotherapy, consisting of bleomycin, etoposide and cisplatin, with complete response. At 6-month followup computerized tomography (CT) revealed progression of a mediastinal lymph node. The patient underwent thoracotomy with resection of lymph nodes, which were histologically classified as embryonic carcinoma, and received 3 cycles of cisplatin, etoposide and ifosfamide. CT of the thorax, abdomen and pelvis were negative. Five months later the patient noticed a firm, elevated subcutaneous tumor below the left scapula proximal to the thoracotomy scar. Ultrasonography and CT showed a 17 3 30 mm. tumor (fig. 1). The mass was removed surgically and histological examination revealed embryonic carcinoma elements identical to the primary testicular tumor (fig. 2). No other manifestation was detected. The patient received local radiation therapy. At completion of the radiotherapy another subcutaneous tumor was detected cranially to the previously detected tumor and outside the previous surgical and irradiated site. Histological examination confirmed embryonic carcinoma components. At the time of detection and removal of the second subcutaneous metastasis CT of the thorax showed multiple lung metastases with 4 lesions in the right lung and 1 in the left lung. The patient had normal serum levels of a-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase. He was treated with paclitaxel, bleomycin, etoposide and cisplatin. Brain metastases were diagnosed and treated with palliative radiotherapy. The patient died 15 months after the initial diagnosis of a metastatic skin lesion. DISCUSSION

Thyroid carcinoma metastatic to the skin: A cutaneous manifestation of a widely disseminated malignancy

Background: Cutaneous metastases develop in 2% to 9% of patients with an internal malignancy. Thyroid carcinoma metastatic to the skin is a rare clinical entity. Objective: Our purpose was to study the clinical and pathologic features and outcome in patients with cutaneous metastasis from thyroid carcinoma. Methods: The study included a retrospective analysis of six patients with skin metastases from thyroid carcinoma and a review of the English-language literature since 1964. Results: Including our six patients, 43 patients with skin metastases from thyroid carcinoma have been reported. Papillary carcinoma was the most common (41%), followed by follicular (28%), anaplastic (15%), and medullary carcinomas (15%). The scalp was the most common site of metastasis. For our patients, the average length of survival after diagnosis of cutaneous metastasis was 19 months. Conclusion: Cutaneous metastasis from thyroid carcinoma is rare and occurs in the setting of disseminated neoplastic disease. (J Am Acad Dermatol 1997;36:531-7.)