Literature meta-analysis of zosteriform cutaneous metastases from melanoma and a clinico-histopathological report from India

Abstract

Cutaneous metastases in patients with malignant tumours are an important clue to tumour progression or even the first manifestation of malignancy. Among the various topographic patterns of cutaneous metastasis, the zosteriform pattern of metastasis is rare, and very few cases have been published. Various theories have been proposed for this zosteriform pattern of metastases, but none have been proved. We collected the available PubMed articles on zosteriform skin metastasis from cutaneous melanoma published since 1970 and reviewed the cases, including our own case. Melanoma presents with cutaneous metastasis in up to 44% of patients. Clinicians treating oncology patients should consider zosteriform skin metastasis in the differential diagnosis of zosteriform lesions to avoid inadequate diagnosis and management.

Keywords: carcinoma; herpes zoster; melanoma; meta-analysis; secondary; skin neoplasm.

Figure 1:. Left thigh medial aspect showed multiple papulonodular lesions that coalesced to form a plaque in dermatomal segment L2–L3.

Figure 2:. The sole of the left foot showed a larger ulcerated, ill-defined, pigmented lesion of size 4 cm × 5 cm, present laterally, and a smaller pigmented firm plaque of size 2 cm × 3 cm with well-defined margins and a raised surface, present medially.

Figure 3:. a. Photomicrograph from the primary origin ulcerated site simulated acantholytic bullous lesion in the scanner view (H & E; 100×). b. Photomicrograph exhibiting neutrophilic and fibrinous exudate toward the ulcerated surface (arrow). Tumour cell nests are present deep in the reticular dermis (H & E; 200×). c. Proliferation of single atypical pigmented melanocytes and nests (black arrow) seen in the epidermal layers. Increase in dermal blood vessels with proliferating new vessels present in the dermis (blue arrow) (H & E; 100×). d. Photomicrograph showing dense infiltration of melanoma cells with pigment at places. Atypical cells have descended deep into the reticular dermis (H & E; 100×).

Figure 4:. Photomicrograph from the metastatic site showing a circumscribed tumour nodule of hyperchromatic tumour cells in dermis with no junctional activity (green arrow). A small tumour nest (blue arrow) and perineural tumour focus (black arrow) are seen in upper dermis (H & E; 100×).