Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
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
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
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 - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
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
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
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
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Net letter
2011:77:4;537-537
doi: 10.4103/0378-6323.82430
PMID: 21727723

Cutaneous metastasis of the small cell lung cancer

Gulcin Guler Simsek1 , Ayse Serap Karadag2 , Zeynep Turksen3
1 Department of Pathology, Kecioren Research and Training Hospital, Ankara, Turkey
2 Department of Dermatology, Yuzuncuyil University Hospital, Van, Turkey
3 Department of Plastic and Reconstructive Surgery, Kecioren Research and Training Hospital, Ankara, Turkey

Correspondence Address:
Gulcin Guler Simsek
Department of Pathology, Ankara Kecioren Research and Training Hospital, Ankara
Turkey
How to cite this article:
Simsek GG, Karadag AS, Turksen Z. Cutaneous metastasis of the small cell lung cancer. Indian J Dermatol Venereol Leprol 2011;77:537
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Cutaneous metastases of the different visceral malignancies (0.7-9%) [1],[2] and also skin metastases of the lung cancer are rare, but worsen the prognosis (1-12%). [3],[4],[5]

While skin metastasis rate of large cell lung carcinomas is high, it is low for the squamous and small cell lung carcinomas. In this letter, we present a case of small cell lung carcinoma presenting with a cutaneous metastasis.

A 59-year-old male patient with the diagnosis of small cell lung carcinoma was referred to our clinic with the complaint of a painless, hard, and lumpy nodule on his left shoulder. He had history of chronic obstructive pulmonary disease. A submucosal lesion was observed during the bronchoscopy of the left lower lung lobe 9 months ago. Microscopic examination of the bronchoscopic biopsy revealed the diagnosis of small cell lung carcinoma and he was given four sessions of chemotherapy (Etapocid and Cisplatine). Post-therapeutic abdominal ultrasonography showed no metastasis. Three months after the cancer diagnosis, a lump formed on his left shoulder and progressed slowly.

On dermatological examination, an indurated, erythematous, and hard nodular lesion was detected on his left shoulder. Its largest diameter was 3 cm [Figure - 1]. An excisional biopsy revealed that the tumor was filling all the dermis in a diffuse pattern. There was no relation or invasion to the epidermis above. Tumor cells had hyperchromatic nuclei and high nucleocytoplasmic ratio [Figure - 2]. The mitotic index was high. Immunohistochemically tumor cells expressed cytokeratin7 [Figure - 3], chromogranin, and synaptophysin [Figure - 4]. The cells were negative for cytokeratin 20 and melan-A. Histopathological diagnosis was metastatic small cell lung carcinoma. The patient refused chemotherapy and he died 6 months after the diagnosis of skin metastasis.

Figure 1: Indurated, erythematous, and hard nodular lesion on left shoulder
Figure 2: Light microscopic image, diffusely distributed tumor in all of the dermis (H and E, ×100)
Figure 3: Immunohistochemically tumor cells showing strong positivity with cytokeratin 7 (CK7, ×200)
Figure 4: Tumor cells expressing synaptophysin antigen (Synaptophysin, ×200)

Skin manifestations of the patients with lung cancer were stated mostly as clubbing, cyanosis of lips, and telengiectasia. [3] Other symptoms of lung cancers include hypertrophic osteoarthropathy, acanthosis nigricans, edema, dermatomyositis, scleroderma, pachydermoperiostitis, and cervical lymphadenitis. [3] Patients diagnosed with lung carcinoma are at a substantial risk of metastasis. Even when the disease is detected at an early stage and removed by surgery, relapse with widespread metastases can be rapid. The most likely metastatic route is the hematogenous spread. The basic metastatic course can occur in the following steps: detachment from the primary tumor followed by invasion, intravasation into a vessel, circulation, stasis within a vessel, extravasation, invasion into recipient tissue bed, and proliferation. [2]

Skin metastases of the lung cancer are rare and worsen the prognosis. The rate of the cutaneous metastases changes according to the types. It was found as 0.81% for small cell lung carcinomas. It is much lower compared to adenocarcinomas (2.95%) and squamous cell carcinomas (1.16%) of the lung. Clinical findings include a red-pink, ulcerated nodule and skin metastasis may be the first sign of the tumor. [3],[5] Therefore, it is important for both dermatologists and pathologists to be able recognize and diagnose these metastases.

Although they can occur in any part of the skin, most common sites for cutaneous metastases are chest, back, abdomen, and scalp. [5] Our patient′s cancer was located on left lower pole of the lung, and skin metastasis developed on his left shoulder. Skin metastasis worsens the prognosis of the patients. By the time skin metastasis appear, the neoplasm has usually advanced far. Median survival time after the diagnosis of a cutaneous metastasis is between 2.9 and 4.9 months. [5] Treatment modalities cannot usually change this progress. Our patient died 6 months after the diagnosis of the cutaneous metastasis.

As seen in this case of rare unexpected skin metastasis of small cell lung carcinoma, the skin metastases lack a pathognomonic physical appearance. Therefore, physicians should be vigilant about this entity. Atypical skin lesions of the cancer patients, even they are not on common sites, should be evaluated and biopsies should be done to diagnose metastases and consider further adjuvant and supportive treatments.

References
1.
Hu SC, Chen GS, Lu YW, Wu CS, Lan CC. Cutaneous metastases from different internal malignancies: A clinical and prognostic appraisal. J Eur Acad Dermatol Venereol 2008;22:735-40.
[Google Scholar]
2.
Rosen T. Cutaneous metastases. Med Clin North Am 1980;64:885-900.
[Google Scholar]
3.
Kökçam Ý, Yavrucuoðlu E, Saral Y, Muz H, Çelik P. Skin manifestations of the patients with lung cancer. Turk J Dermatol 1994;3:156-9.
[Google Scholar]
4.
Barbetakis N, Samanidis G, Paliouras D, Samanidou E, Tzimorota Z, Asteriou C, et al. Facial skin metastasis due to small-cell lung cancer: A case report. J Med Case Reports 2009;3:32.
[Google Scholar]
5.
Hürmüz P, Selek U, Zorlu F, Tekuzman G. Lung adenocarcinoma with skin metastasis. Int J Hematol Oncol 2008;18:39-41.
[Google Scholar]

Fulltext Views
116

PDF downloads
75
Show Sections