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Year : 2020  |  Volume : 16  |  Issue : 4  |  Page : 917-918

A cutaneous metastasis of bronchogenic carcinoma: Milia-like lesions with dermatomal pattern


1 Dermatology Clinic, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
2 Pathology Clinic, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey

Date of Submission27-May-2017
Date of Decision18-Jul-2017
Date of Acceptance25-Feb-2018
Date of Web Publication30-Oct-2018

Correspondence Address:
Esra Varnali
Dermatology Clinic, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Zuhuratbaba, Bakirkoy, 34100 Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_450_17

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 > Abstract 


Clinical presentation of cutaneous metastases is often variable. Presented case had an intriguing cutaneous metastasis of bronchogenic squamous cell carcinoma. Lesions were characterized by dermatomal pattern with milia-like papules, plaques, and nodules.

Keywords: Cancer, cutaneous, dermatomal, lung, metastasis, milia like


How to cite this article:
Varnali E, Kavak A, Özkan Y, Karahacioglu FB. A cutaneous metastasis of bronchogenic carcinoma: Milia-like lesions with dermatomal pattern. J Can Res Ther 2020;16:917-8

How to cite this URL:
Varnali E, Kavak A, Özkan Y, Karahacioglu FB. A cutaneous metastasis of bronchogenic carcinoma: Milia-like lesions with dermatomal pattern. J Can Res Ther [serial online] 2020 [cited 2020 Sep 29];16:917-8. Available from: http://www.cancerjournal.net/text.asp?2020/16/4/917/244462




 > Introduction Top


Zosteriform or dermatomal pattern is a rare variant of cutaneous metastases.[1],[2],[3],[4] Although lesions might be seen in different presentations, milia-like papules have not been reported in English literature to our knowledge. We report, herein, an unusual cutaneous metastasis in a case of bronchogenic squamous cell carcinoma (SCC). The patient had milia-like lesions in a dermatomal distribution on the trunk.


 > Case Report Top


A 53-year-old male with lung cancer was consulted for his skin lesions starting 1 month ago. The patient has been diagnosed as Stage 4 SCC of the lung (right upper lobe) for 1 year. Eastern Cooperative Oncology Group performance status of the patient was Grade 3. Therefore, systemic chemotherapy was not recommended. Only palliative radiotherapy was performed due to symptomatic lung lesions.

Dermatological examination showed 1–3 mm, asymptomatic, yellow-white, milia-like papules coalescing into nodules and plaques on an erythematous base. Lesions were distributed on the upper trunk mostly on the right side. In some areas, dermatomal pattern was noticed [Figure 1]. He denied previous herpes zoster infection. Histopathology of skin biopsy revealed extensive dissemination of tumor cells of SCC [Figure 2]. The patient died 3 weeks later due to tumor progression and pneumonia.
Figure 1: Milia-like papules and plaques in a dermatomal pattern

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Figure 2: Histopathology of skin biopsy revealed extensive dissemination of tumor cells of squamous cell carcinoma (H and E, ×4)

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 > Discussion Top


A zosteriform pattern of cutaneous metastases was rarely reported in prostate, lung, and transitional cell carcinomas and cutaneous SCC as well.[2],[3] In addition, a meta-analysis reviewed 4774 patients published in the English literature since 1970 and found 56 cases with zosteriform pattern in cutaneous metastases. There were 8 (14%) lymphomas, 7 (12%) breast cancers, 7 (12%) SCCs, 6 (11%) gastrointestinal tumors, 6 (11%) respiratory tumors (5 lung tumors and 1 larynx tumor), and 4 (7%) urogenital tumors.[4]

Cutaneous metastases generally develop in proximity of a primary tumor.[5] Local, lymphatic, and/or hematologic or neural invasions could contribute to the development of zosteriform or dermatomal pattern. In our patient, lesions were located on the upper trunk mostly on the right side where his primary tumor existed. Less but similar lesions were observed on the opposite side. Few lesions were detected in the posterior trunk. There were no lesions in the arm where similar lesions would be expected in case of the involvements of C5 and T1 dermatomes. Although the arrangement of the lesions did not show an exact match, they were roughly in line with dermatomes between C4 and T3. Maybe, direct local invasion of the original tumor may cause dermatomal-like appearance in addition to neural invasion hypothesis.

The terminologies of “zosteriform” and “dermatomal” are questionable in case of bilateral distribution as in our case. The term “zosteriform” could be more appropriate If the lesions are unilateral, and the term “dermatomal” when distribution is bilateral as in our patient.

Lesions in zosteriform metastases could be macular, erythematous, papular, nodular, erosive, or ulcerative.[1],[4] Milia-like papules, however, have not been reported before. The yellow-white color of papules seen in our patient was quite unique. The mechanism of how tumor cells could produce this unique clinical presentation is questionable. This atypical clinical presentation together with dermatomal distribution might mimic a benign tumor and cause confusion.

Cutaneous metastases are rare and indicate an extremely poor prognosis. Survival is typically only about 3 months in patients with disseminated skin metastases.[6] Our patient died in a short period of time during follow-up. Considering our patient together with previous reports, dermatomal distribution seems to be no effect to survival time.

In conclusion, as novel treatment strategies extend survival of malignancies, clinicians will encounter various types of cutaneous metastases with confusing clinical presentations. It should be noted that cutaneous metastases can mimic benign tumors even milia as in this case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Matarasso SL, Rosen T. Zosteriform metastasis: Case presentation and review of the literature. J Dermatol Surg Oncol 1988;14:774-8.  Back to cited text no. 1
    
2.
Shafqat A, Viehman GE, Myers SA. Cutaneous squamous cell carcinoma with zosteriform metastasis in a transplant recipient. J Am Acad Dermatol 1997;37:1008-9.  Back to cited text no. 2
    
3.
Bianchi L, Orlandi A, Carboni I, Costanzo A, Chimenti S. Zosteriform metastasis of occult bronchogenic carcinoma. Acta Derm Venereol 2000;80:391-2.  Back to cited text no. 3
    
4.
Savoia P, Fava P, Deboli T, Quaglino P, Bernengo MG. Zosteriform cutaneous metastases: A literature meta-analysis and a clinical report of three melanoma cases. Dermatol Surg 2009;35:1355-63.  Back to cited text no. 4
    
5.
Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: A clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol 2004;31:419-30.  Back to cited text no. 5
    
6.
Terashima T, Kanazawa M. Lung cancer with skin metastasis. Chest 1994;106:1448-50.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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