eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
5/2018
vol. 35
 
Share:
Share:
more
 
 
abstract:
Letter to the Editor

Multiple disseminated keratoacanthoma-like nodules: a rare form of distant metastases to the skin

Alina Jankowska-Konsur, Karolina Kopeć-Pytlarz, Zdzisław Woźniak, Anita Hryncewicz-Gwóźdź, Joanna Maj

Adv Dermatol Allergol 2018; XXXV (5): 535-537
Online publish date: 2018/07/19
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Cutaneous metastases are found in approximately 0.7–10.4% of internal malignancies and they may rarely be the first symptom of the underlying neoplasm [1]. Typically, cutaneous secondaries present as a single, erythematous nodule, occasionally ulcerated, however, other presentations, including erysipelas carcinomatosa, alopecia neoplastica or carcinoma en cuirasse in the course of the breast cancer, or angiomatous tumors in the course of renal carcinoma may be occasionally observed. The metastases assimilating keratoacanthomas are extremely rare [2, 3].
Herein, we present a 72-year-old man, cigarette smoker, who was referred to our department with disseminated skin tumors of unknown etiology. On admission, dome-shaped, inflamed tumors, some of them with central, keratin-filled craters, clinically mimicking keratoacanthomas were observed on the scalp, forehead, nose, neck and trunk (back and left shoulder) (Figures 1, 2). All the lesions developed rapidly during the 2-month period preceding hospitalization.
The patient had a history of prostate cancer (Gleason score 3+3) treated with radiotherapy and hormonal therapy 4 years ago, hypertension and emphysema. He also suffered from liver cirrhosis secondary to viral hepatitis B, followed by hepatocellular carcinoma treated with transcatheter arterial chemoembolization (TACE) a year ago.
On admission, laboratory tests revealed leukopenia (2370/mm3), anemia (RBC 4.10 × 106/µl, HGB 13.0 g/dl), thrombocytopenia (49000/µl), elevated aspartate aminotransferase (AST) and -glutamyl transferase (GGT) serum levels (78 U/l and 65 U/l, respectively, and D-dimers (6.65 µg/ml). Moreover ultrasound examination of the abdomen showed multiple hyperechogenic lesions covering the liver and X-ray of the thorax showed disseminated round shadows in both middle and lower lung fields.
Biopsy of the skin lesion obtained from the forehead revealed metastatic poorly differentiated carcinoma of unknown origin (Figure 2). The immunochemistry staining showed positive reaction for epithelial membrane antigen (EMA) however other markers (pan-cytokeratin, S-100, Melan A, PSA, AMCAR and CEA) were negative. The expression of Ki67 antigen was lower than 10. Mitotic activity was assessed as 2–3 mitoses per HPF (high power field).
On the computed tomography (CT) scan, new liver tumors were observed and the patient was referred to the Angiosurgery Department to have TACE. During the subsequent therapeutic...


View full text...
references:
Reingold IM. Cutaneous metastases from internal carcinoma. Cancer 1966; 19: 162-8.
Briasoulis E, Pavlidis N, Felip E; ESMO Guidelines Working Group. Cancers of unknown primary site: ESMO clinical recommendation for diagnosis, treatment and follow-up. Ann Oncol 2008; 19 Suppl 2: 106-7.
van de Wouw AJ, Jansen RL, Speel EJ, Hillen HF. The unknown biology of the unknown primary tumour: a literature review. Ann Oncol 2003; 14: 191-6.
Reich A, Kobierzycka M, Woźniak Z, et al. Keratoacanthoma-like cutaneous metastasis of lung cancer: a learning point. Acta Derm Venereol 2006; 86: 459-60.
Riahi RR, Cohen PR. Clinical manifestations of cutaneous metastases: a review with special emphasis on cutaneous metastases mimicking keratoacanthoma. Am J Clin Dermatol 2012; 13: 103-12.
Lin JH, Lee JY. Primary cutaneous CD30 anaplastic large cell lymphoma with keratoacanthoma-like pseudocarcinomatous hyperplasia and marked eosinophilia and neutrophilia. J Cutan Pathol 2004; 31: 458-61.
Sreedevan V, Nair SP, Kumar GN, et al. Keratoacanthoma like secondaries on the scalp. Indian J Dermatol Venereol Leprol 2009; 75: 523-4.
Ellis DL, Riahi RR, Murina AT, Cohen PR. Metastatic laryngeal carcinoma mimicking eruptive keratoacanthomas: report of keratoacanthoma-like cutaneous metastases in a radiation port. Dermatol Online J 2014; 20: pii: 13030/qt3s43b81f.
Anzalone CL, Cohen PR. Generalized eruptive keratoacanthomas of Grzybowski. Int J Dermatol 2014; 53: 131-6.
Reed KB, Cook-Norris RH, Brewer JD. The cutaneous manifestations of metastatic malignant melanoma. Int J Dermatol 2012; 51: 243-9.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe