Metastatic Skin Tumors



Metastatic Skin Tumors


Christine J. Ko, MD

David Cassarino, MD, PhD










This patient with a history of melanoma on the chest has an unusual presentation of metastatic melanoma, with numerous 1-3 mm black-red papules.






This metastatic melanoma shows a lack of epidermal involvement, and is composed of nests of atypical cells with melanin pigment in the dermis.


TERMINOLOGY


Definitions



  • Metastatic tumor originating from skin


CLINICAL ISSUES


Presentation



  • Melanoma



    • Cutaneous metastases



      • Nodule or papule, often pigmented, may be ulcerated, multiple or solitary


      • Rarely the presenting sign of disease


      • Occasionally primary tumor site cannot be determined


    • Nodal metastases



      • Most commonly in regional, draining lymph nodes


    • Distant metastases



      • Any site, including bone, gastrointestinal tract, lung, brain


    • Blue nevus-like melanoma



      • Blue macule/papule, often near original site of primary melanoma


  • Merkel cell carcinoma



    • Spreads to lymph nodes in up to 50-75% of cases


    • Distant metastasis in up to 30-50% of cases



      • Other sites of metastasis include liver, lungs, bone, brain


  • Squamous cell carcinoma (SCC)



    • Nonspecific nodules, often pink to red


    • Rarely zosteriform pattern


  • Basal cell carcinoma (BCC)



    • Very rarely metastasizes to other sites (lymph nodes, bone, parotid, lungs, other internal organs)


  • Dermatofibrosarcoma protuberans (DFSP)



    • Essentially only fibrosarcomatous cases


    • Often history of multiple local recurrences


    • Rarely metastasizes



      • Lung most common site; also lymph nodes, bone, soft tissue


  • Many other cutaneous malignancies may metastasize



    • Adnexal carcinomas



      • Sebaceous carcinoma: Relatively high incidence of metastasis


      • Microcystic adnexal carcinoma (extremely rare, with history of multiple recurrences)


      • Apocrine and eccrine carcinomas


      • Aggressive digital papillary adenocarcinoma (typically to lungs)


    • Sarcomas that involve dermis


Treatment

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Metastatic Skin Tumors

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