Cutaneous metastasis from hepatocellular carcinoma as the first clinical sign

Abstract

Hepatocellular carcinoma (HCC) is a tumor whose incidence has been increasing in recent years. The occurrence of cutaneous metastases from HCC, as the first sign of onset, is very unusual. We report a case of cutaneous metastasis from HCC appearing as a shoulder abscess and being the first clinical sign of the disease. We also examined the few published cases, and the diagnosis, treatment, and survival rate for this disease. Metastases of HCC should be included in the differential diagnosis of growing lesions in unusual localizations. Biopsies are required to confirm the diagnosis. The diagnosis of HCC from a cutaneous lesion is very uncommon and is associated with a poor prognosis.

Cutaneous Metastases from Primary Hepatobiliary Tumors as the First Sign of Tumor Recurrence following Liver Transplantation

“…Although recurrence of HCC following liver transplantation has significantly declined since the adoption of the Milan criteria, 8–12% of patients will still develop recurrence with the majority of these patients developing advanced forms of multifocal and extrahepatic metastases. The most common metastatic sites are lung, bones, lymph node, and adrenal glands; cutaneous metastases occur much less frequently [4]. …”

“…Cutaneous metastases from HCC most commonly occur in the face, scalp, chest, and shoulders and appear as single or multiple 1–5 cm lesions, which are often firm and reddish blue. Ulceration is often absent and rapid growth is common [4, 8]. These skin lesions may resemble pyogenic granulomas [5] or subcutaneous abscesses [4] or have a hemangiomatous morphology with profuse bleeding due to tumor hypervascularity [6].…”

Metastatic Hepatocellular Carcinoma to the Skin Staining Positive With HMB-45

“…4,6 The face and scalp are the most common locations. 9 Patients that exhibit extrahepatic metastasis usually have advanced intrahepatic tumors.…”

“…1,3 Metastasis to skin is uncommon. 1,[4][5][6][7][8][9] Rarely, the cutaneous metastasis of HCC precedes the diagnosis of the primary tumor. 4,6 The histopathologic diagnosis of HCC is aided by the use of the relatively specific immunoperoxidase marker Hep Par 1.…”

“…1,[4][5][6][7][8][9] Rarely, the cutaneous metastasis of HCC precedes the diagnosis of the primary tumor. 4,6 The histopathologic diagnosis of HCC is aided by the use of the relatively specific immunoperoxidase marker Hep Par 1. 10 Our patient presented with a nonspecific papule on the nose felt by the clinician to represent nonmelanoma skin cancer.…”