Author(s): Saeed S, Keehn CA, Morgan MB
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Abstract BACKGROUND: Cutaneous tumor metastasis may be the first manifestation of cancer, but more often is a harbinger of advanced disease that portends an ominous prognosis. All skin accessions over the past 10 years from a large Veterans Administration (VA) hospital were reviewed. METHODS: Archived histories, glass slides, and the immunohistochemical battery (IHC), were assessed to determine diagnostic accuracy. RESULTS: Of the 100,453 cases reviewed, there were a total of 77 cases (75 males and 2 females) of cutaneous metastasis from the lungs (28.6\%), metastatic melanoma (18.2\%), gastrointestinal tract (14.2\%), genitourinary tract (10.4\%), head and neck (9.1\%), hematologic (5.2\%), breast (5.2\%), and miscellaneous (<2\%). Metastasis represented the first indication of an internal malignancy in 7.8\% of cases. The cutaneous sites of involvement included the head and neck (28\%), the trunk (40\%), the extremities (18\%), and multiple sites (14\%). The age range was 38-83 years, with a mean of 62 years. The average time interval between diagnosis of internal malignancy and cutaneous presentation was 33 months (range: <1 month-22 years), and the average survival following diagnosis was 7.5 months (range: <1 month-8 years). In a cohort of subjects, a truncated immunohistochemical battery consisting of CK-7, CK-20, and S-100 was consistent with the expected staining pattern of the primary source of cutaneous metastasis in 83.33\% of the patients. CONCLUSIONS: Excluding the potential for age and gender bias in this study conducted in a VA setting, cutaneous metastases represent an uncommon, deadly, and late-developing occurrence in many patients. Compared with previous studies, lung carcinoma remains the most common of the cutaneous metastases, with a relative rise in the incidence of metastatic melanoma. The immunohistochemical battery of CK-7, CK-20, and S-100 is a helpful adjunct in narrowing the differential diagnosis of the primary site of a large proportion of cutaneous metastases, particularly tumors with an epithelioid appearance such as carcinomas and melanomas.
This article was published in J Cutan Pathol
and referenced in Journal of Clinical Case Reports