Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
doi: 10.4103/0378-6323.120745
PMID: 24177624

Cutaneous metastasis of an advanced prostate cancer

Mohammad Abid Keen, Iffat Hassan
 Department of Dermatology, STD and Leprosy, Government Medical College and Associated SMHS Hospital, Srinagar, Kashmir (J and K), India

Correspondence Address:
Mohammad Abid Keen
Iqbal Abad, KP Road, Near Masjid Usman, Anantnag - 192 101, Kashmir
How to cite this article:
Keen MA, Hassan I. Cutaneous metastasis of an advanced prostate cancer. Indian J Dermatol Venereol Leprol 2013;79:828-829
Copyright: (C)2013 Indian Journal of Dermatology, Venereology, and Leprology


Primary visceral malignancies uncommonly present with skin involvement with a reported incidence between 2% and 9% and their presence is indicative of an advanced disease and poor prognosis. The most common tumors to metastasize to skin are breast, lung, colorectal, renal and ovarian carcinomas. [1] Despite the high incidence of prostatic cancer, cutaneous and subcutaneous metastases of this cancer are extremely rare, seen in <1% cases. We report a case of an elderly male with carcinoma of the prostate with multiple cutaneous metastases.

A 70-year-old man presented with 1 month history of multiple skin colored to erythematous papulonodular lesions variable in size over the pubic region and inner aspects of thigh. These lesions first appeared over the suprapubic area and progressively increased in size and involved inner aspects of thighs and left inguinal region. These lesions were associated with discomfort, but were not associated with ulceration and bleeding. About a year back, he had presented to the emergency department with urinary retention. He was diagnosed to have carcinoma of the prostate and his prostate-specific antigen (PSA) level was found to be 210 ng/ml.

Transrectal ultrasound guided biopsy was carried out, which revealed poorly differentiated prostatic adenocarcinoma with a Gleason score of 9 in all the 8 core biopsies performed. There was no perineural invasion or extraglandular extension. A staging bone scan was performed at the time of diagnosis, which did not show any evidence of bony involvement.

Patient underwent a complete androgen blockade with Buserelin and Cyproterone acetate. Almost 1 year after the diagnosis, patient noted development of cutaneous lesions at the pubic region. These lesions were considered to be cutaneous metastases from the prostatic cancer. Patient also complained of multiple bone pains, loss of weight and appetite. Repeat bone scan revealed multiple metastatic lesions of pelvic bones.

Cutaneous examination revealed multiple erythematous dome shaped papueonodular lesions, with a smooth shiny surface, varying in size from 5 mm to 1 cm presenting over the suprapubic region, left inguinal region and inner aspect of left thigh [Figure - 1]. These lesions were non-tender, firm in consistency and fixed to the overlying skin, but not to the underlying structures. Scrotum was normal, but penis was thick, edematous infiltrated and deformed in shape. Rest of the mucocutaneous examination was unremarkable. Systemic examination of the patient was also normal.

Figure 1: Multiple erythematous dome shaped papulonodular lesions, ranging in size from 5 mm to 1 cm

Routine investigations showed a hemoglobin of 7.8 g/dl and increased liver enzymes (serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase). Fine needle aspiration cytology revealed adenocarcinomatous cells of uncertain origin. Excisional biopsy of one of the papules revealed stratified squamous epidermis on the surface, with rows and prostate acini-like glandular structures appearing due to the ectatic lymphatic spaces due to the lymphangiectasia secondary to metastasis blocking lymphatics [Figure - 2]. PSA level was also elevated.

Figure 2: Histopathological image of one of the papules revealing prostate acini-like glandular structures appearing due to ectatic lymphatic spaces due to lymphangiectasia secondary to metastasis blocking lymphatics (H and E, ×40)

Radiographs of pelvis revealed diffuse osteosclerotic lesions. Chest radiograph as well as ultrasound abdomen were normal. Patient was subjected to palliative care with radiotherapy to the pelvic bones.

Cutaneous metastases from internal malignancies are relatively rare, seen in about 2-9% of malignancies. [2] Cutaneous metastases occur more commonly with mammary, pulmonary, renal and colonic cancers and are seen in the advanced stage of malignancy, associated with a poor prognosis. Although carcinoma of the prostate is common, it is responsible for lesser than 1% of cutaneous metastases.

Cutaneous metastases from prostatic carcinoma are usually asymptomatic and may occur at single or multiple sites. [3] The most common sites involved are the lower abdomen, genitalia and thighs. [4] Metastatic lesions are usually papules and nodules and they rarely ulcerate. They may have a zosteriform distribution or may appear as sclerodermoid lesions. Other rare manifestations include priapism, penile metastasis, gynecomastia and breast metastasis. Skin metastases from prostatic cancer are an ominous finding and most of the patients die within 6 months.

Although the mechanism of cutaneous involvement is not well-understood, suggested routes include embolization of vessels, dissemination through lymphatics and through perineural lymphatics.

Immunohistochemistry is an important tool in establishing organ of origin when histology is not conclusive. [5] A large majority of metastatic adenocarcinomas are P501S positive (99%). A small subset of metastatic prostatic adenocarcinoma shows significant differences in staining intensity and extent of PSA and P501S and therefore combined use of these markers may result in increased sensitivity for detecting prostatic origin. [6] Cutaneous metastases from a prostatic carcinoma signifies an advanced stage, aggressive behavior and a grave prognosis, with disease specific survival lesser than 6 months. Thus, the treatment at this stage is palliative care, which includes keeping the lesions dry and clean. Debridement is a good option for bleeding or crusting lesions.

Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: A meta-analysis of data. South Med J 2003;96:164-7.
[Google Scholar]
Spencer PS, Helm TN. Skin metastases in cancer patients. Cutis 1987;39:119-21.
[Google Scholar]
Steinkraus V, Lange T, Abeck D, Mensing H, Ring J. Cutaneous metastases from carcinoma of the prostate. J Am Acad Dermatol 1995;32:665-6.
[Google Scholar]
Jones C, Rosen T. Multiple red nodules on lower abdomen. Metastatic carcinoma of the prostate. Arch Dermatol 1992;128:1532, 1535.
[Google Scholar]
Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: A clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol 2004;31:419-30.
[Google Scholar]
Sheridan T, Herawi M, Epstein JI, Illei PB. The role of P501S and PSA in the diagnosis of metastatic adenocarcinoma of the prostate. Am J Surg Pathol 2007;31:1351-5.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections