Cutaneous metastases of internal malignancies: a single‐institution experience

Abstract

Aims Cutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer. Materials and methods A retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases. Results We identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender. Conclusion Breast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.

Sister Mary Joseph's Nodules

“…About 1%–10% of internal malignancies present with cutaneous metastases, 16% of which are localized to the umbilicus (Vernemmen et al, 2022). Sister Mary Joseph's nodules were named after the surgical assistant who first linked umbilical nodules with abdominopelvic cancers in 1949 (Gabriele et al, 2005).…”

Black Salve (or escharotics). A picture about an unorthodox medical preparation in oncology

“…While the Black Ointment cauterises the surface of the body, the cancer continues to grow in deeper layers without being affected by the ointment. Accordingly, metastases are common in some skin cancer types like malignant melanoma and can affect visceral tissues like the brain, lung or liver (distant metastases—not in the skin) 46,47 . They are more critical for the course of the disease, but not affected by the ointment.…”

“…Accordingly, metastases are common in some skin cancer types like malignant melanoma and can affect visceral tissues like the brain, lung or liver (distant metastases—not in the skin). 46 , 47 They are more critical for the course of the disease, but not affected by the ointment. Also, the psychological aspects should not be disregarded.…”

Metástasis cutánea en cáncer de estómago en Perú y revisión de literatura

“…Los tumores gastrointestinales son causa de metástasis cutánea y representan el 26.2 y 7.3% en varones y mujeres, respectivamente, siendo más frecuente por cáncer colorrectal, esófago y páncreas. La metástasis cutánea es rara en los casos de cáncer gástrico, con una incidencia notificada < 5% 1,2 .…”