Drug name tamoxifen: Nolvadex An 80‐year‐old caucasian woman was seen in November 1997 for an asymptomatic raised lesion on the left side of the neck extending to the infraclavicular area of 7 months’ duration. She had been treated with topical steroids by her general practitioner with no relief. On examination, there was a large, irregular, ill‐defined, indurated, erythematous plaque, 7 × 4 cm, over the left side of the neck extending to the infraclavicular area ( ). The diagnoses entertained included tinea incognito, cutaneous mucinoses, and carcinoma erysipeloides. 1 Infiltrated plaque of carcinoma erysipeloides on the left side of the neck General examination and breast examination were normal with no mass palpable, and there was no regional lymphadenopathy. Routine blood investigations were normal. A biopsy taken from the plaque revealed marked dilation of dermal lymphatics containing a tightly packed infiltrate of pleomorphic malignant cells with abnormal mitotic figures, confirming the diagnosis of carcinoma erysipeloides ( ). The tumor cells were estrogen receptor positive, supporting the origin of cells from the breast. A mammogram showed the presence of a small spiculated mass in the lower outer quadrant of the left breast. This was considered to be the source of the cutaneous metastasis and the patient was started on tamoxifen. 2 Dilated lymphatics packed with malignant infiltrate: carcinoma erysipeloides

Fifty patients (26 men and 24 women) with cutaneous metastases were studied clinically and histologically. Analysis on the basis of the site of the primary tumor showed carcinoma of the lung and esophagus to be the commonest tumors responsible in men and carcinoma of the breast and ovaries the commonest in women. Metastases occurred in all areas of the skin with the chest wall the commonest site, especially in carcinoma of the breast. Most of the cutaneous metastases occurred after the primary malignancy was manifest and well advanced; only in two cases were they the presenting signs of the malignancy.

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