Neurofibroma like nodules on shoulder: First sign of gastric adenocarcinoma

Abstract

Cutaneous metastasis is a relatively uncommon manifestation of visceral malignancies. It most often occurs late in the course of a disease but may also be the first presenting sign of advanced visceral cancer. The average incidence of cutaneous metastasis from a visceral neoplasm is 5.3 percent. The incidence of cutaneous metastases from carcinomas of the upper digestive tract has been reported as less than 1 percent. Cutaneous metastases of gastrointestinal tumors are usually nodular and their typical location is in the abdominal wall. A 68-year-old woman presented with a three-month history of painless nodules on the right side of her neck. Skin examination revealed two joined nodules on the right side of her neck. The nodules were skin colored, well-circumscribed, non-motile, soft, and non-tender. Histopathological examination of the skin growth revealed diffuse infiltration of the dermis and subcutaneous tissue by tumoral cells. A diagnosis of metastatic gastric carcinoma was made. However,various cutaneous metastases have been reported as erysipelas-like, zosteriform, and epidermoid cyst-like. Cutaneous metastases must always be distinguished from primary skin tumors. This report emphasizes the need for appropriate investigation of newly appearing, unusual, or persistent skin lesions such as non-healing ulcers, persistent indurated erythemas, and all skin nodules of undetermined causes.