Elsevier

Dermatologic Clinics

Volume 26, Issue 1, January 2008, Pages 89-102
Dermatologic Clinics

Tumor Invasion of the Skin

https://doi.org/10.1016/j.det.2007.08.004Get rights and content

This article discusses several solid organ and hematologic neoplasms that can metastasize to the skin. Special emphasis is placed on the most frequent solid and hematological malignancies that have cutaneous metastases, including breast cancer, melanoma, lung cancer, colon cancer, and leukemia. In addition, mammary and extramammary Paget's disease are further discussed as examples of direct extension of primary tumors to the skin.

Section snippets

Metastasis

The most accepted definition of metastasis in the literature is “a neoplastic lesion arising from another neoplasm with which it is no longer in contiguity” [1], [2]. Lambert and Schwartz [3] suggested that in the context of dermatology, the following definition is more appropriate: “a neoplastic lesion arising form another neoplasm with which it is no longer in contiguity or in close proximity within the same tissue.” Their rationale is that in certain cutaneous neoplasms regression may have

Solid organ malignancies that metastasize to the skin

Cutaneous metastases from solid primary tumors are uncommon, accounting for only 0.7% to 9% of all metastases. The relative incidence and site of origin of metastatic skin disease correlates with the most common types of primary cancer in each gender (Table 1). Melanoma has recently been reported to be the most common cancer that metastasizes to skin in men (32% of all cases), whereas breast cancer is the most common type of skin metastasis in women (69% of all cases) [14]. Other common primary

Hematologic malignancies that metastasize to the skin

Cutaneous metastasis can also occur in hematologic malignancies, such as leukemia and lymphoma [1], [34]. Skin involvement may appear similar for both types of diseases, and the lesions can arise at any time during the course of the disease. Morphologically, the lesions present as macules, papules, plaques, and nodules that are pink, red, and brown to purple [34], [35], [36]. They are usually firm and characteristically painless [37]. They may also present as palpable purpura, ulcers, or

Malignancies that directly extend to the skin

Another mechanism of cutaneous spread of malignancy is by way of direct extension. As an example of this kind of spread, This article will discuss Paget's disease of the breast (PDB) and extramammary Paget's disease (EMPD). Although there has been some debate about the pathogenesis of this epidermal malignancy, it is most commonly accepted that the cutaneous findings of PDB and certain cases of EMPD represent the direct extension of an underlying adenocarcinoma.

Summary

Cutaneous metastasis from internal malignancies can be difficult to diagnose. Skin lesions can present as skin-colored or erythematous, firm nodules, but other morphologies can occur, such as alopecia neoplastica in breast cancer, and a bleeding nodule on the scalp in renal carcinoma. Clinicians need to be aware of clinical presentations of such metastases, because their detection can help make a primary diagnosis of a disease and restage a patient who has known disease, and may alter treatment

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