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. 2021 Oct;38(5):916-920.
doi: 10.5114/ada.2021.108457. Epub 2021 Aug 15.

Neglected malignant neoplasms with cutaneous involvement

Grażyna Kaminska-Winciorek  1 , Bożena Cybulska-Stopa  2 , Maksymilian Gajda  3   4 , Marta Pawełczak-Szastok  1 , Adrianna Gęga-Czarnota  5
Affiliations

Neglected malignant neoplasms with cutaneous involvement

Grażyna Kaminska-Winciorek et al. Postepy Dermatol Alergol. 2021 Oct.
No abstract available

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A – Advanced left breast cancer (cT4N1M1). A 53-year-old female pharmacist living in the countryside (married, with 2 children) had been watching the growth of her left breast for several years. The patient was afraid of an oncological diagnosis, so she did not see a doctor or inform her family. Within the left breast, there is an infiltrative tumour accompanied by a board-like skin infiltrate, with a tendency to erythema, and an orange-peel symptom with numerous scaly lesions accompanied by yellow scabs in the course of advanced breast cancer with secondary skin involvement. The histopathological (HP) examination showed infiltrative breast cancer (oestrogen and progesterone positive, HER2 +++, Ki 67 20-30%). B – Advanced right breast cancer (cT4N1M1). A 49-year-old unemployed woman, with elementary education, living in the countryside with her husband and 2 children, had observed an increase of a right breast tumour for several months. The patient’s family (husband) was aware of the situation but was unable to convince her to see a doctor. The patient was afraid of being diagnosed with neoplastic disease. In the area of the right breast, a huge, necrotic tumour with a diameter of 20 cm was found, with a tendency to disintegrate and bleed, to form rocking granulation tissue, with numerous fissures and ulcerations filled with pus and fibrin. The infiltrative tumour compressed the armpit and infiltrated the surrounding tissues of the right armpit, décolletage, and the adjacent subcostal area diagnosed as advanced breast cancer with the secondary skin involvement. HP examination confirmed infiltrating breast cancer (oestrogen and progesterone receptor positive, HER-2 negative, Ki67 30–40%)
Figure 2
Figure 2
A – Subungual melanoma pT4b. A 73-year-old single male patient, living in the countryside, with secondary level of education was admitted to the Oncology Clinic due to a bleeding, extensive ulcerative black tumour within the distal phalanx of the right third finger. In the interview, the tumour had been developing for several months, ignored by patient, who was afraid of surgical excision. Initially, he considered the tumour as post-traumatic haematoma. The patient repeatedly removed the tumour and the nail plate himself, which resulted in its growth. Clearly visible black hyperpigmentation is found within the dorsal and bulbar surfaces of the distal phalanx of the right hand, with a light pink infiltration, exfoliation, and complete destruction of the nail plate in the course of the subungual melanoma approved in the HP (pT4b). B – Stage III skin melanoma (inoperable). A 78-year-old male, widowed, city inhabitant, with secondary education, currently retired, came to the Oncology Clinic for the first time in 2014 because of an infiltrative, black solid tumour 3 cm in diameter, localized in the left cheek area, clinically suggesting a diagnosis of melanoma. The patient did not come for the biopsy, delaying the diagnostic proceedings for another 30 months. He did not want to undergo surgical procedures and potential oncological therapy. A large infiltrative-decaying tumour was seen within the left cheek, pressing on the lower eyelid, eye socket, penetrating into the maxillary sinus, filled with necrotic masses, thick mucus-bloody discharge. In the vicinity of the tumour, there is a purple swelling and black discoloration. In November 2016, a core-needle biopsy of a giant cheek tumour and a fine-needle biopsy of submandibular lymph nodes were performed. The histopathological examination confirmed the presence of melanoma metastasis in the left submandibular node. Because the patient did not agree to further diagnostics, it was not possible to assess the staging of the disease according to TNM. He also did not agree to be hospitalized or to receive systemic treatment
Figure 3
Figure 3
A – Basal cell carcinoma-locally advanced. A 78-year-old retired woman with primary education, living in the city with her husband, had observed the growth of tumour of the nose for 15 years. Despite her daughter’s repeated requests, she did not go to the doctor. She was afraid of the surgical procedures. Extensive infiltration, ulceration with destruction of the left nasal wing, nasal bridge, and turbinates, with penetration into the left maxillary sinus in the course of locally advanced basal cell carcinoma confirmed BCC. Due to the lack of the possibility of applying local treatment, the patient was qualified for treatment with vismodegib and is currently undergoing this treatment. B – Basal cell carcinoma-locally advanced. A 68-year-old retired man with basic education, living in the countryside, married, had been observing a tumour of the right side of his face for several years. Despite repeated requests from his family, he did not go to the doctor (he was afraid of the final surgical procedures). Extensive ulceration covering the right part of the face with destruction of the lower eyelid of the right eye, right auricle, with destruction of the muscular fascia, with infiltration of the occipital area and the nape in the course of locally advanced basal cell carcinoma were proven also in histopathological assessment. Due to its advanced stage and the inability to perform local treatment, a systemic therapy with vismodegib was initiated
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