The presentation, pathology, and current management strategies of cutaneous metastasis

Abstract

Skin metastases are rare in the routine clinical practice of dermatology, but are of major clinical significance because they usually indicate advanced disease. We reviewed the literature on skin metastasis regarding recent trends in clinical presentation and diagnosis of the most common cutaneous lesions. An extensive literature review was conducted using PubMed from May 26, 2011 to July 16, 2013 relating cutaneous metastases. Articles chosen for reference were queried with the following prompts: "Cutaneous metastases", "clinical presentation", "histological features", and "immunohistochemistry". Further searches included "treatment" and "management" options for "metastatic breast", "metastatic colorectal", "metastatic melanoma", "metastatic lung", and "hematologic cancers." We also reviewed the literature on the current management of melanoma as a model for all cutaneous metastatic disease. Our own clinical findings are presented and compared to the literature. Additionally, we highlight the most useful immunohistochemical studies that aid in diagnoses. Several novel therapies and combination therapies such as electrochemotherapy, vemurafenib, and imiquimod will be discussed for palliative treatment of cancers that have been found to improve cutaneous lesions. We review these notable findings and developments regarding skin metastases for the general dermatologist.

Keywords: Cutaneous metastasis; Images; Immunohistochemistry; Skin metastasis.

Figure 1

(a) Gingival metastases from a primary chondrosarcoma.(b) Firm nodule at the base of the ear from a primary lung cancer. (c) Two subcutaneous firm nodules in the clavicular fossa from metastatic lung cancer. (d) Isolated firm nodular lesion from metastatic colon cancer

Figure 2

(a) Cellulitis-like appearance of metastatic breast cancer.(b) Plaque-like area with multiple nodules from a primary breast cancer. (c) Massive recurrence of breast cancer on the chest wall and abdomen of the “en cuirasse” type. (d) Breast cancer, metastatic to the thoracic spine with extension to the skin, and lceration secondary to radiation therapy

Figure 3

(a) Cellulitic-type appearance with multiple nodules in metastatic breast cancer of the shoulder and upper back. (b) Merkel cell carcinoma reveals neoplastic cells in the dermis. A CAM 5.2 stain reveals perinuclear staining (original magnification, 400×).(c) Metastatic squamous cell carcinoma of the skin reveals neoplastic cells in the dermis (cytokeratin 5/6 stain; original magnification, 100×). (d) Neoplastic cells are noted in the dermis. A HER2/neu stain is positive and decorates the neoplastic cells in the dermis indicating possible metastasis from breast carcinoma (original magnification, 200×)