Targetoid cutaneous metastasis from breast carcinoma
Department of Dermatology and STD, Dr. BR Ambedkar Medical College, Bangalore - 560 045
|How to cite this article:
Singh G, Mohan M, Srinivas C, Valentine P. Targetoid cutaneous metastasis from breast carcinoma. Indian J Dermatol Venereol Leprol 2002;68:51-52
To the Editor:
A 40 - year - old woman operated for lump on the right breast 6 months back, presented with abdominal distension, breathlessness on exertion and swelling of feet of 2 weeks duration. General physical examination revealed pallor, bilateral pitting oedema feet and generalised lymphadenopathy (nontender, firm and mobile). Hepatosplenomegaly and fluid thrill were evident on abdominal examination. Other systemic examination was normal. Dermatological examination revealed an irregular, firm, ill- defined, mildly tender lump on the right breast under the postoperative scar. Multiple, discrete, firm to indurated papulonodular lesions and annular plaques fixed to the skin but not to underlying structures were present asymmetrically over the right mammary and intermammary regions. Some of the lesions had hyperpigmented depressed centres giving a targetoid appearance [Figure - 1].
Investigations revealed anaemia (Hb-9.3g%), and raised ESR (102mm first hr). Other hematological and biochemical parameters were within normal limits. Ultrasonography abdomen showed evidence of secondaries in the liver and abdominal cavity. FNAC of lymph node was suggestive of metastatic carcinoma of breast. Biopsy from a skin nodule showed nests of tumour cells.
Cutaneous metastases are not uncommon and frequently are the first sign of extranodal metastatic cancer of head and neck. Various morphological patterns of cutaneous metastasis from breast carcinoma, sclerodermatoid pattern, alopecia neoplastica, zosteriform and pigmented malignant melanoma like cutaneous metastases have been documented. Targetoid appearance was an interesting feature of the cutaneous metastasis in this case.
Lookingbill DP Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective of 4020 patients. J Am Acad Dermatol 1993; 29:228-236.[Google Scholar]
Ebner H, el -Mansy E. Telangiectatic carcinoma and erysipeloid carcinoma. Clinical and histological aspects of this special clinical manifestation of secondary skin carcinoma. Dermatol Monatsschr 197.1; 157: 188 - 194.[Google Scholar]
Yamamoto T, Yokoyama A. Eosinophil infiltration in the sclerodermoid cutaneous metastasis of a breast cancer. J Dermatol 2000; 27:552 - 553.[Google Scholar]
Mallon E, Dawber RP Alopecia neoplastica without alopecia: a unique presentation of breast carcinoma scalp metastasis. J Am Acad Dermatol 1994; 31: 319 - 321.[Google Scholar]
Manteaux A, Cohen PR, Rapini RP Zosteriform and epidermotropic metastasis. Report of two cases. J Dermatol Surg Oncol 1992; 18:97-100.[Google Scholar]
Shamai - Lubovitz 0, Rothem A, Ben-David E, et al. Cutaneous metastatic carcinoma of the breast mimicking malignant melanoma, clinically and histologically. J Am Acad Dermatol 1994; 31:1058 - 1060.[Google Scholar]