cutaneous metastases

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CUTANEOUS METASTASES Dr Ahmed Essop Dermatology:

CUTANEOUS METASTASES Dr Ahmed Essop Dermatology

CLINICAL HISTORY:

CLINICAL HISTORY 48 years female patient, referral from department of surgery: clinical problems: Background history of invasive ductal breast ca. (Grade III) Modified radical mastectomy and adjuvant chemotherapy (2009)

DIFFERENTIAL DIAGNOSIS:

DIFFERENTIAL DIAGNOSIS DFSP Cutaneous metastatic breast carcinoma Keloid

INVESTIGATIONS:

INVESTIGATIONS Routine blood results: Normal Radiological investigations: Normal

HISTOLOGY :

HISTOLOGY

PATIENT 2:

PATIENT 2

PATIENT 3:

PATIENT 3

CUTANEOUS METASTASES:

CUTANEOUS METASTASES

DEFINITION:

DEFINITION Precocious metastases Metachronous metastases Synchronous metastases

EPIDEMIOLOGY:

EPIDEMIOLOGY Prevalence (cutaneous metastases): 2% Their incidence varies from 0.2 to 8.5 per 1000 population Breast, colon, lung, uterus, and kidneys Saeed S, Keehn C.A, Morgan M.B. J Cutan Pathol 2004; 31:419–430

EPIDEMIOLOGY:

EPIDEMIOLOGY MALE FEMALE BREAST 69% COLON 19% 9% MELANOMA 13% 5% OVARIES 4% LUNGS 24% 4% ORAL CAVITY 12% Lookingbill DP, Spangler N, Helm KF. J Am Acad Dermatol 1993, 29:228-236

EPIDEMIOLOGY:

EPIDEMIOLOGY Melanoma (45% of cutaneous metastatic cases) Breast (30%) Head and neck ( <20%) Lookingbill DP, Spangler N, Helm KF. J Am Acad Dermatol 1993, 29:228-236 .

PATHOGENESIS:

PATHOGENESIS

CLINICAL PRESENTATION:

CLINICAL PRESENTATION Painless, firm, freely mobile, nodule, skin coloured to erythematous base

MALIGNANT MELANOMA:

MALIGNANT MELANOMA About 4 -10% of the metastatic melanomas: unknown primary Stains: S-100, HMB-45, Fontana Masson (detects melanin granules), vimentin, Melan A/Mart-1, tyrosinase and microphthalmia transcription factor. Yang CH, Yeh JT, Lo YF, et al. Dermatol Surg 2003; 29: 990.

BREAST CARCINOMA:

BREAST CARCINOMA Cutaneous metastases: chest wall. Clinically: cutaneous thoracic, abdominal nodules, alopecia areata-like lesions, telangiectatic ca., and Paget’s disease. Staining: oestrogen receptors, progesterone receptors and CK7.

BRONCHOPULMONARY MALIGNANCIES:

BRONCHOPULMONARY MALIGNANCIES Cutaneous metastases (men): chest, abdomen, upper lip and back. Other sites: scalp, neck, face, extremities and pelvis. Stains: thyroid transcription factor-1(TTF), neuronspecific enolase (NSE), chromogranin, synaptophysin and calretinin.

GASTROINTESTINAL MALIGNANCIES:

GASTROINTESTINAL MALIGNANCIES Cutaneous metastases: abdomen and pelvis “Sister Mary Joseph Nodule” Stains: mucicarmine, Alcian blue, periodic acid Schiff (PAS), CDX2, CK7, CK20, CEA (carcino-embryonic antigen) and EMA (epithelial membrane antigen).

GYNAECOLOGICAL MALIGNANCIES:

GYNAECOLOGICAL MALIGNANCIES Cutaneous metastasis: rare Subcutaneous nodules on the chest, back, abdomen, lower extremity, axilla, neck and scalp. Stains: CA-125, CK7, CK20.

HEAD AND NECK MALIGNANCIES:

HEAD AND NECK MALIGNANCIES Cutaneous metastasis: extremely rare Erythematous infiltrating plaques on the supraclavicular and infraclavicular regions. Stains: cytokeratin cocktail (AE1/AE3) and p53.

HAEMATOLOGICAL MALIGNANCIES:

HAEMATOLOGICAL MALIGNANCIES Leukaemia cutis appear as macules, papules, plaques, nodules and skin ulcers. Immunohistochemistry: CD68 chloroacetate esterase (Leder stain), and myeloperoxidase The negative reactivity for CD20, CD3, rules out obvious lymphoid malignancies .

TREATMENT:

TREATMENT Chemotherapy: Topical imiquimod, PDT Radiotherapy Immunotherapy Surgery : local excision, Laser , ECT (electrotherapy) Stetler-Stevenson WG. Invasion and metastases 2005:113-127

PROGNOSIS:

Cutaneous metastasis: the prognosis is guarded. PROGNOSIS

CONCLUSION:

CONCLUSION Rare, poor prognosis Histological features similar, but not identical to the primary malignancy The therapeutic response of cutaneous metastases may mirror the systemic response

REFERENCES:

REFERENCES Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol 1993, 29:228-236. Sariya D, Ruth K, Adams-McDonnell R, et al. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. Arch Dermatol 2007 , 143:613-620 Kanitakis J. Immunohistochemical diagnosis of malignant melanoma. Ann Dermatol Venereol 1990; 117: 689. Saeed S, Keehn C.A, Morgan M.B. Cutaneous metastasis: A clinical, pathological and immunohistochemical appraissal. J Cutan Pathol. 2004; 31: 419-430

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