Lower Extremity Cutaneous Lesions as the Initial Presentation of Metastatic Adenocarcinoma of the Colon

Abstract

Cutaneous metastases from colorectal cancers are rare and are usually present on the abdominal wall or previous surgical incision sites. Remote cutaneous lesions have been reported, however, often occur in the setting of widespread metastatic disease including other visceral secondaries. We present a case of lower extremity cutaneous metastases as the first sign of metastatic disease in a patient with adenocarcinoma of the colon. This case illustrates that new skin lesions may be the initial presentation of metastatic disease in a patient with a history of cancer.

Rare Case of Colonic Metastasis

“…6 However, they may be solitary and of varied morphology, including ulcers, carcinoma erysipelatoides, alopecia neoplastica, cicatricial and zosteriform. 6 They may invoke a rapid inflammatory response in surrounding skin, mimicking cellulitis.…”

“…6 However, they may be solitary and of varied morphology, including ulcers, carcinoma erysipelatoides, alopecia neoplastica, cicatricial and zosteriform. 6 They may invoke a rapid inflammatory response in surrounding skin, mimicking cellulitis. 6 As colonic mucosa expresses cytokeratin CK20 but not CK7, this profile CK20+/CK7-can be used to identify a metastatic deposit as arising from colorectal primary.…”

“…6 They may invoke a rapid inflammatory response in surrounding skin, mimicking cellulitis. 6 As colonic mucosa expresses cytokeratin CK20 but not CK7, this profile CK20+/CK7-can be used to identify a metastatic deposit as arising from colorectal primary. 5 There is much speculation regarding the mode of spread of CRC to skin.…”

“…In the case of metastases to abdominal wall, colostomy sites and surgical incisions, there may be direct extension via surgical tracts or implantation of tumor cells at surgery. 6,7 In cases with remote cutaneous disease and associated visceral metastases, there may be hematogenous spread of tumor cells which get trapped by capillary beds of the overlying skin. 6,7 The flaw in this explanation is that it considers purely mechanical factors and is inadequate if there are no liver and lung metastases as in this case.…”

“…6,7 In cases with remote cutaneous disease and associated visceral metastases, there may be hematogenous spread of tumor cells which get trapped by capillary beds of the overlying skin. 6,7 The flaw in this explanation is that it considers purely mechanical factors and is inadequate if there are no liver and lung metastases as in this case. An alternative explanation may be that circulating tumor cells bind specifically to the skin by site-specific adhesion molecules and or respond preferentially to growth factors found there.…”