Radiation port cutaneous metastases: Reports of two patients whose recurrent visceral cancers presented as skin lesions at the site of previous radiation and literature review

Abstract

Radiation therapy is associated with a variety of complications, including the development of primary skin cancers in the radiated region. However, it is rare for patients with visceral cancers who are treated with radiation therapy to subsequently develop cutaneous metastasis within the radiation port. We describe two patients with internal malignancies who developed cutaneous metastases within their radiation ports following radiotherapy. In addition, we used PubMed to perform an extensive literature review and identify additional reports of cutaneous metastasis within a radiation port. We excluded patients who developed melanoma or primary skin cancers in the radiation port. We also excluded patients with non-solid organ malignancies. Herein, we summarize the characteristics of 23 additional patients who experienced radiation port cutaneous metastases and explore possible mechanisms for the occurrence of radiation port cutaneous metastases.

Cutaneous Metastasis From Tonsillar Squamous Cell Carcinoma: Report and Review of the Literature

“…In our patient, cutaneous metastases presented on the neck and proximal chest, which was the former site of his radiation therapy port. A recent review of cutaneous metastases within radiation ports noted that breast cancer was the most common tumor to metastasize to sites of prior radiation therapy [ 8 ]. Moreover, radiation port metastases have also been described in patients with other primary malignancies [ 8 ].…”

“…A recent review of cutaneous metastases within radiation ports noted that breast cancer was the most common tumor to metastasize to sites of prior radiation therapy [ 8 ]. Moreover, radiation port metastases have also been described in patients with other primary malignancies [ 8 ]. It has been hypothesized that the appearance of the cutaneous metastases within radiation ports may result from the development of cutaneous immunocompromised districts [ 9 ]; ionizing radiation damages the skin and alters the immune response, thereby rendering the patient vulnerable to an isoradiotopic response that manifests as cutaneous metastasis [ 9 - 10 ].…”

Radiation port cutaneous metastases: A further example of immunocompromised district

“…We read with great interest the report recently published in the Indian Journal of Dermatology by Hoyt and Cohen,[ 1 ] which describes two patients with internal malignancies who developed cutaneous metastases within their radiation ports following radiotherapy (RT). [ 1 ] In both cases, cutaneous metastases, strictly localized on the irradiated zone, appeared some months after the last cycle of RT, suggesting induction by ionizing radiation (IR). [ 1 ]…”

“…[ 1 ] In both cases, cutaneous metastases, strictly localized on the irradiated zone, appeared some months after the last cycle of RT, suggesting induction by ionizing radiation (IR). [ 1 ]…”

“…[ 2 ] Less commonly, treatment with IR may be associated with the appearance of metastasis from internal malignancy to the irradiated skin. [ 1 ] The mutagenic effect of IR can well account for the oncogenic potential of irradiated areas, but other factors can concur in this direction. In fact, as Hoyt and Cohen themselves noticed,[ 1 ] an irradiated area is prone to the development not only of tumors, but also of opportunistic infections and immune-mediated skin disorders, depicting a typical example of ‘immunocompromised cutaneous district’ (ICD).…”