Patterns of Cutaneous Metastasis

Brownstein, Martin H.

doi:10.1001/archderm.1972.01620090034008

Cited by 418 publications

(347 citation statements)

References 18 publications

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“…To further support the observations above, we compiled 444 skin metastasis cases from 7 previous reports with different primary tumors and corresponding regional distribution data [10,11,15,18,[22][23][24] and from 2 lung cancer-specific studies [25,26]. These data strongly support the notion that lung cancer preferentially produces chest (and less frequently head and neck) skin metastases, while colorectal cancer prefers abdominal skin locations in more than two thirds of the cases (Fig.…”

Section: Anatomical Distribution Of Skin Metastases Of Visceral Cancerssupporting

confidence: 57%

“…Studies performed during the past 50 years found that about 1 to 5 % of all visceral malignancies form skin metastasis [9]. Nevertheless, the prevalence may increase due to the longer survival of cancer patients [10][11][12]. Although skin is usually involved in a later stage of progression, it is the first sign of dissemination in a small fraction of cases [13][14][15].…”

Section: Homage a Pagetmentioning

confidence: 99%

“…Melanoma and primary tumors in proximity to the skin (e.g., breast or head and neck cancer) preferentially produce skin metastases by locoregional spreading using mostly the lymphatic dissemination route [10,11,[13][14][15]. In contrast, the mechanism for skin metastasis tumors residing in the body cavities is far less understood.…”

Section: Vascular Anatomy and Lymphovascular Disseminationmentioning

confidence: 99%

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Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

Kovács

Hegedűs

Kenessey

et al. 2013

Cancer Metastasis Rev

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Metastasis of human cancer is an organ-selective process that is determined by anatomical and biological factors as well as by specific microenvironmental properties. Dissemination of visceral malignancies to the skin is rather rare and usually occurs in a later stage of the disease. Using statistical approaches, both positive (renal and lung cancers) and negative (pancreatic and liver cancers) organ preferences can be identified in a variety of cancers. While certain cancer types are characterized by random distribution for skin metastasis (liver cancer), a number of cancers demonstrate a colonization preference to the region of origin: lung cancer to the supradiaphragmatic (mostly chest) and colorectal cancers to the infradiaphragmatic (abdominal) skin regions. In certain cases, however, skin metastasis develops more frequently at specific distant locations, as evidenced by the dissemination of renal cancer at the head and neck region. These findings are clinically relevant and useful especially in patients where skin metastasis is the first indication of a malignancy. Nevertheless, it is a strong argument for the predominant role of microenvironmental factors in cancer dissemination. On the other hand, skin metastases of visceral cancers provide a unique model to analyze the pathomechanisms determining organ selectivity, including the organ-specific vascularization, the dermatome-specific innervation, or immunological and developmental factors.

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Section: Anatomical Distribution Of Skin Metastases Of Visceral Cancerssupporting

confidence: 57%

Section: Homage a Pagetmentioning

confidence: 99%

Section: Vascular Anatomy and Lymphovascular Disseminationmentioning

confidence: 99%

See 1 more Smart Citation

Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

Kovács

Hegedűs

Kenessey

et al. 2013

Cancer Metastasis Rev

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“…This cutaneous involvement generally arises in the head, neck, and trunk region [1]. Among patients with bronchogenic carcinoma, 2.8-7.5% will develop cutaneous metastases (via haematogenous spread), particularly in tumours of the upper lobes [5].…”

Section: Discussionmentioning

confidence: 99%

Metastatic Pulmonary Adenocarcinoma Deposit Arising Within a Cutaneous Basal Cell Carcinoma: A Case Report

Carey

Jones

Griffiths

et al. 2011

Head and Neck Pathol

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Skin metastases are rare complications of internal malignancies, and most commonly arise from primary lung carcinoma (Brownstein and Helwig in Arch Dermatol 105:82-68, 1972). Metastatic cutaneous lesions have not previously been documented to arise within other skin tumours. We report our experience of a solitary pulmonary adenocarcinoma metastasis that arose within a preexisting basal cell carcinoma in a patient with undiagnosed lung cancer. Immunohistochemistry was invaluable in confirming both the metastatic nature of the secondary skin lesion and its site of origin.Keywords Adenocarcinoma Á Basal cell carcinoma Á Skin Á Metastasis Á Thyroid transcription factor-1 Á Tumour-to-tumour metastasis Case PresentationAn 83-year-old male was referred by his general practitioner (GP) to the maxillofacial department at Morriston Hospital, Swansea, UK complaining of a slow growing, painless skin nodule on the left neck present for several months. The GP also wrote to inform the department that the patient was concurrently being investigated for chest pain and shortness of breath on exertion.On examination, there was a 2 cm fleshy lesion over the left posterior triangle (Fig. 1). There was no associated ulceration, induration, or surrounding erythema, and no cervical lymphadenopathy or other cutaneous lesions were noted. The treatment, from a surgical point of view, was a wide elliptical excision with 5 mm margins, and the specimen was sent for histopathological examination.Hematoxylin and eosin (H&E) stained sections revealed nests and lobules of hyperchromatic, uniform, basaloid cells with peripheral palisading and loose stroma, consistent with basal cell carcinoma (BCC). In between these classic areas of BCC were irregular nests of highly atypical cells characterized by abundant eosinophilic cytoplasm, irregular nuclei, fine chromatin, and one or more prominent nucleoli. Mitotic figures were readily identified. Similar cells were identified in lymph-vascular spaces (Fig. 2). This pleomorphic population had features suggestive of squamous cells. In fact, the lesion was initially reported as a BCC with co-existent squamous cell carcinoma, the latter most likely derived from the former, i.e. a baso-squamous carcinoma. Immunohistochemical staining of the skin tumour confirmed the dimorphic nature of the lesion, with strong EMA positivity in the pleomorphic squamoid dermal and intra-lymphatic deposits. In contrast, the basal cell component was EMA negative.A chest X-ray, performed for his concurrent respiratory symptoms, was highly suggestive of a primary lung cancer with nodal and distant metastases, with a provisional radiologic staging of T4 N3 M1. A CT-guided core needle biopsy was reported as a non-small cell carcinoma of the Electronic supplementary material The online version of this article

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“…It is therefore quite distinctive from secondary deposits of breast cancer in the skin, which typically occur either in the skin of the ipsilateral anterior chest wall or axilla, or occur as multiple disseminated metastatic seeds in a widespread disposition. 270,271 Like primary breast cancers and like the aggressive digital papillary adenoma/ low-grade papillary adenocarcinoma of the digits, primary ductal eccrine adenocarcinoma is an aggressive tumor that has a high risk of disseminated metastatic seeding.…”

Section: Introduction and Clinical Featuresmentioning

confidence: 99%

Malignant adnexal neoplasms

2006

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Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics. Modern Pathology (2006) 19, S93-S126. doi:10.1038/modpathol.3800511Keywords: eccrine carcinoma; sebaceous neoplasia Malignant tumors of the pilosebaceous apparatus, their mimics and precursors IntroductionTumors of the pilosebaceous unit can occur in isolation or in combination with complex proliferations showing multilineal differentiation patterns encompassing those of sweat ducts, epidermis and stroma with its varied components. In this review, we will focus upon the malignant adnexal proliferations, considering benign entities mainly insofar as they impact the diagnostic approach to adnexal carcinoma. We will first turn to the malignant sebaceous neoplasms, their precursors and their mimics. Sebaceous adenoma Clinical FeaturesThe sebaceous adenoma is a benign neoplasm that manifests clinically as a pale yellow nodular lesion, typically of the face, that expresses itself clinically after the age of 50. Tumors range in size from o1 to 45 cm. [1][2][3][4][5][6] These lesions are associated with the Muir-Torre syndrome, comprising the coexpression of cutaneous neoplasms, including those of sebaceous type with well-differentiated squamous epithelial neoplasms, and visceral malignancies, including carcinomas of the breast, ovary, gastrointestinal tract and larynx. [7][8][9][10][11][12][13][14] An occasional patient may manifest a malignant lymphoma of nodal or extranodal type. 10,12,14 Sebaceous neoplasms in the setting of Muir-Torre syndrome are often difficult to classify, showing overlap features between all of the prototypic forms of sebaceous neoplasm ranging from hyperplasia to carcinoma. 13 HistologyThe prototypic sebaceous adenoma manifests 1-2 layers of germinitive cells which mature to form central sebocytes, and have an architecture comprising a sharply circumscribed sebaceous lobule surrounded by a compressed pseudocapsule of dermal stroma ( Figure 1a). The overlying epidermis may be attenuated, but sometimes forms a collarette around the peripheral aspect of the neoplasm. Unlike sebaceous hyperplasia, occasional mitoses may be seen in the lobules of a sebaceous adenoma and in concert with this nucleoli may be somewhat prominent, but the pleomorphism, hyperchromasia and individual cell necrosis of the se...

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Patterns of Cutaneous Metastasis

Cited by 418 publications

References 18 publications

Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

Metastatic Pulmonary Adenocarcinoma Deposit Arising Within a Cutaneous Basal Cell Carcinoma: A Case Report

Malignant adnexal neoplasms

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