LETTER

Hippokratia 2014, 18(2):187

Papadopoulos I1, Ioannides D2, Lefaki I1
1Dermatology Department of State Hospital for Skin and Venereal Diseases, 2First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece

 

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Key words: cutaneous metastasis, retrospective study, Northern Greece, internal malignancy

Corresponding author: Ioanna Lefaki, State Hospital for Skin and Venereal Diseases, Thessaloniki, Greece, tel: +302313308884, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Dear Editor,

Besides primary skin neoplasms, skin may also be affected by tumours, either by cutaneous metastasis from an internal organ malignancy, as paraneoplastic manifestation of various internal organ neoplasms or by direct invasion of an adjacent organ1.

Cutaneous metastasis is defined as the dissemination of malignant cells from a primary tumor to the skin2. Metastasis to the skin is more common in neoplasms of breast, lung, colon, stomach, uterus and kidney. Skin metastasis may be the first clinical finding, or a sign of recurrence or end-stage disease3. Misdiagnosis of such lesions is therefore critical.

The aim of this retrospective study was the evaluation of all the cases of cutaneous metastases from internal organ malignancy, between the years 1974 and 2010 in a tertiary dermatological center in Northern Greece. A retrospective analysis of all histologically and clinically confirmed cutaneous metastases has been conducted. Data were extracted from registries available between 1974 and 2010 regarding patient characteristics (place of origin, sex, and age), lesion characteristics (site, morphology, clinical presentation) and primary tumour characteristics (type of tumour, organ involved, if diagnosed or not at time of presentation). Newly diagnosed cases per year were calculated in order to evaluate any differences between years. 

Overall, 37 cases (22 females and 15 males) have been identified in the database. Average age of patients was 63.3 years old with the average age of men at 61.5 years and that of women at 64.4 years. (60%) percent of cases were females and 40% males. Regarding the place of origin, 35% of the patients were residents in large urban cities (more than 100.000 people population), whereas the remaining 65% were residents in small urban cities and rural areas (less than 100.000 people population). Regarding the clinical morphology of the metastatic lesion, 38% was a plaque, 54% a nodule, 5% ulcer and 3% of other clinical morphology.

As for the primary tumor in men, 13% were diagnosed with lung cancer, 7% with primary hepatic cancer and 7% with gastrointestinal tract cancer at the time of presentation, whereas 73% of cases were undiagnosed at the time of presentation. As far as the primary tumor in women is concerned, 68% were diagnosed with breast cancer and 5% with Hodgkin lymphoma at the time of presentation, whereas 27% of the cases were undiagnosed. Overall 44% of all cases were undiagnosed at time of presentation. The cases were distributed throughout the years as follows: 1 case in each year 1975, 1976, 1980, 1984, 1987, 1992, 1993, 1995, 1998, 2001, 2003, 2006, 2 cases in each year 1982, 1989, 1991, 1994, 3 cases both in 2008 and 2009, 4 cases in 2010 and 7 cases in 1990. Cutaneous metastasis can also be a result of melanoma, which is also common.

The role of the dermatologist for a patient with skin metastases of an unknown internal cancer is very important, since he might be the first doctor to make the diagnosis of the primary tumor.

Conflict of interest

No conflict of interest.

References

1. Hussein MR. Skin metastasis: a pathologist’s perspective. J Cutan Pathol. 2010; 37: e1-e20.
2. Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: a clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol. 2004; 31: 419-430.
3. Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. [Survival after cutaneous metastasis: a study of 200 cases]. Ann Dermatol Venereol. 2001; 128: 1310-1315.