Cutaneous metastasis

Author: Vanessa Ngan, Staff Writer, 2005.


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What is cutaneous metastasis?

Cutaneous metastasis (plural ‘metastases’) refers to growth of cancer cells in the skin originating from an internal cancer. In most cases, cutaneous metastasis develops after the initial diagnosis of the primary internal malignancy (such as breast cancer and lung cancer) and late in the course of the disease. In very rare cases, skin metastasis may occur at the same time or before the primary cancer has been discovered and may be the prompt for further thorough investigation.

Cutaneous metastasis may also occur from a skin cancer, usually melanoma. The original or ‘primary’ melanoma produces metastases or ‘secondary’ growths in surrounding or distant skin sites and other tissues such as the lungs or brain.

Cutaneous metastases 

What causes cutaneous metastasis?

Cutaneous metastasis occurs when cancerous cells break away from the primary tumour and make their way to the skin through the blood circulation or lymphatic system. Most malignant tumours can produce skin metastasis, but some are more likely to do so than others. When the following cancers have metastasised, they have quite a high chance of affecting the skin.

  • Melanoma — 45% chance of developing cutaneous metastasis (but only 15–20% of melanomas metastasise, so the overall chance of a skin metastasis is about 7–10%)
  • Breast cancer — 30%
  • Nasal sinus cancers — 20%
  • Cancer of the larynx — 16%
  • Cancer of the oral cavity — 12%

The incidence of skin metastasis varies but is somewhere between 3—10% in patients with a primary malignant tumour.

The sex and age of an individual also appears to determine the frequency of skin metastasis in certain primary cancers. The reason for this is unknown.

Organ of cancer origin% Skin metastasis in women% Skin metastasis in men
Breast 69 0
Colon 9 19
Melanoma 5 13
Ovaries 4 0
Lung 4 24
Oral cavity 12

Below lists the common internal cancers that cause skin metastasis in decreasing order of frequency according to sex and age group.

MenWomen
< 40 yr> 40 yr< 40 yr> 40 yr
Melanoma
Colon cancer
Lung cancer
Lung cancer
Colon cancer
SCC in the oral cavity
Melanoma
Breast cancer
Colon cancer
Ovarian cancer
Breast cancer
Colon cancer
Lung cancer
Ovarian cancer
Melanoma

What are the signs and symptoms of cutaneous metastasis?

Most cutaneous metastasis occurs in a body region near the primary tumour. The first sign of the metastasis is often the development of a firm, round or oval, mobile, non-painful nodule. The nodules are rubbery, firm or hard in texture and vary in size from barely noticeable lesions to large tumours. These may be skin coloured, red, or in the case of melanoma, blue or black. Sometimes multiple nodules appear rapidly. The skin metastases may break down and ulcerate through the skin. Specific patterns include:

  • Carcinoma erysipeloides: sharply demarcated red patch due to local spread of primary cancer blocking lymphatic blood vessels in adjacent skin
  • En cuirasse or sclerodermoid carcinoma: indurated fibrous scar-like plaques due to cancer cells infiltrating collagen in the skin
  • Carcinoma telangiectoides: red patches with numerous blood vessels (telngiectases) or lymphatic vessels (lymphangioma-like).

Depending on the location of the primary tumour, cutaneous metastasis display certain characteristic features.

Organ of cancer originFeatures of cutaneous metastasis
Breast
  • Most common sites of metastasis are the chest and abdomen
  • Less common sites include scalp, neck, upper extremities and back
  • Some patients may develop a firm scar-like area in the skin. If this occurs on the scalp, hair may be lost (alopecia neoplastica)
  • Lesions may appear as inflammatory plaques with a clear cut raised margin (carcinoma erysipeloides)
Lung
  • Most common sites are the chest, abdomen and back
  • Reddish firm nodules suddenly appear in the skin
  • Nodules tend to follow the intercostal vessels when they appear on the chest
Melanoma
  • In men, metastasis occurs on the chest, extremities and back
  • In women, metastasis to the lower extremities is more common
Colon and stomach
  • Common sites are the abdomen and the pelvis
  • A nodule appearing at the umbilicus is called a Sister Mary Joseph nodule and is a sign of extensive colorectal cancer

What is the treatment for cutaneous metastasis?

The underlying primary tumour needs to be treated. However, in most cases where skin metastasis has occurred, the primary cancer is widespread and may be untreatable. In this case, palliative care is given and includes keeping lesions clean and dry. Debridement can be done if lesions bleed or crust. Other therapies that may be helpful include:

In many cases, cutaneous metastasis causes disfigurement and discomfort. Removal of skin lesions by simple excision may enhance the patient’s quality of life but has little effect on the final outcome that is dictated by the primary cancer.

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Text: Miiskin