obsolete metastasis to skin

Metastasis to Skin: An Obsolete Concept

According to search results, metastasis to the skin was previously considered an obsolete concept [1]. However, with advancements in medical research and diagnosis, it has become a significant consideration in cancer treatment.

Characteristics of Metastasis to Skin

Metastasis to the skin refers to the growth of cancer cells in the skin originating from internal cancer [10]. This condition is often associated with advanced cancer and can be a sign of poor prognosis. In most cases, cutaneous metastasis develops after the initial diagnosis of the primary internal malignancy and late in the course of the disease [10].

Incidence and Distribution

Cutaneous metastases are uncommon, accounting for only 2% of all skin neoplasms [11]. The incidence varies depending on the primary cancer site. For example, men are more likely to develop cutaneous metastasis from lung (25%), colon, melanoma, kidney, or upper aerodigestive tract cancers, while women are more likely to develop it from breast (69%), lung, melanoma, kidney, or ovary cancers [12].

Common Sites for Skin Metastases

Metastatic Cancer to Skin: Signs and Symptoms

Metastatic cancer to skin, also known as cutaneous metastasis, occurs when cancer cells from another part of the body spread to the skin. The signs and symptoms of this condition can vary depending on the type of cancer and its location in the body.

• Nodules or Lesions: One of the most common signs of cutaneous metastasis is the development of firm, round or oval nodules or lesions on the skin (10). These nodules are often rubbery, firm or hard in texture and can vary in size from barely noticeable to large tumors.
• Malodor and Necrosis: Malignant wounds associated with cutaneous metastasis may present as crater-like ulcers or raised nodules with a cauliflower-like appearance, accompanied by malodor and necrosis (1).
• Pain and Tenderness: Advanced cutaneous metastases can be very painful and tender to the touch (6). The skin lesions can also become friable, crusted, or ulcerated.
• Swollen Lymph Nodes: In some cases, cutaneous metastasis may cause swollen lymph nodes in the affected area (15).
• Other Symptoms: Depending on the location of the primary tumor and the extent of metastasis, other symptoms such as weakness, local tenderness, mental disturbances, depression, etc. can occur (8).

Timing of Signs and Symptoms

The timing of the signs and symptoms is important to determine the condition. Metastatic cancer to skin can develop in days to weeks, and the skin nodules are often skin-colored, matching the background skin (13). In some cases, the nodules may become red due to inflammation.

References:

• [1] M Starace · 2022
• [6] AK Conlin · 2022
• [8] Oct 15, 2020
• [10]
• [13]
• [15]

Diagnostic Tests for Metastasis to Skin

Metastasis to the skin, also known as cutaneous metastases, can be a sign of advanced cancer. While there are various diagnostic tests available, some may be more relevant than others in detecting metastasis to the skin.

• Skin Biopsy: A skin biopsy is often considered the gold standard for diagnosing skin cancer and detecting metastasis. This involves removing a sample of skin tissue, which is then examined under a microscope by a pathologist [11].
• Imaging Tests: Imaging tests such as CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, and bone scans can help identify metastases in other parts of the body, including the skin [8]. However, these tests may not always detect small or superficial metastases.
• Blood Tests: Blood tests, such as lactate dehydrogenase (LDH) levels, may be used to monitor cancer progression and detect potential metastasis. Elevated LDH levels can indicate advanced disease [1].
• Immunohistochemical Marker Studies: These studies use antibodies to check for certain cancer markers in a tissue sample. They may be used to confirm a diagnosis of metastatic skin cancer [4].

Other Relevant Tests

While not specifically designed to detect metastasis, other tests may also be relevant in the context of skin cancer:

• Electrochemotherapy: This treatment combines a low dose of chemotherapy with electrical impulses to help manage symptoms and potentially reduce tumor size [9].
• Immunohistochemistry (IHC): IHC uses antibodies to check for certain cancer markers in a tissue sample. It may be used to confirm a diagnosis of metastatic skin cancer [13].

References

[1] Blood tests aren’t used to diagnose melanoma, but some tests may be done before or during treatment, especially for more advanced melanomas.

[4] A skin biopsy, either punch or excisional, is the preferred test for diagnosis. Special laboratory testing such as immunohistochemical marker studies may be performed.

[8] What tests will be done to diagnose metastasis? · Biopsy. · Blood tests. · Bone scans. · CT (computed tomography) scans. · MRI (magnetic resonance imaging) scans.

[9] Electrochemotherapy (sometimes called ECT) combines a low dose of a chemotherapy drug with electrical impulses. It's given to help with the symptoms of skin cancer.

[11] Skin biopsy can provide a definitive diagnosis of cancer. Additional procedures check whether the cancer has spread.

[13] If this happens, special lab tests will be done to confirm a diagnosis. They might include the following: Immunohistochemistry (IHC) Uses antibodies to check for certain cancer markers in a tissue sample.

Treatment Options for Obsolete Metastasis to Skin

Obsolete metastasis to skin refers to the spread of cancer cells from an internal organ or tissue to the skin, where they have already been treated and are no longer active. In such cases, treatment options focus on managing symptoms, preventing further growth, and improving quality of life.

Targeted Therapy Drugs

For melanoma skin cancer that has metastasized to the skin, targeted therapy drugs can be effective. These include a combination of BRAF inhibitors and MEK inhibitors (e.g., dabrafenib and trametinib) [4]. This treatment approach is particularly useful for thinner, more superficial skin metastases [6].

Immunotherapy

Another option is immunotherapy, which uses the body's immune system to fight cancer cells. For skin cancer, treatments like imiquimod cream or cemiplimab can be used [7].

Other Treatment Options

In some cases, other treatment options may include:

• Topical treatments: Imiquimod 5% cream, cryotherapy, and 5-fluorouracil 5% cream can be useful for thinner, more superficial skin metastases [6].
• Cemiplimab: A drug that uses the body's immune system to kill cancer cells.
• Aldesleukin: An immunotherapy treatment approved for melanoma.

References

• The FDA-approved combination of dabrafenib and trametinib is effective in treating melanoma skin cancer [4].
• Targeted therapy drugs, such as BRAF inhibitors and MEK inhibitors, can be used to treat melanoma with obsolete metastasis to the skin [5].
• Imiquimod cream or cemiplimab can be used for immunotherapy treatment of skin cancer [7].

Note: The information provided is based on the search results and may not reflect the most up-to-date or comprehensive information available.

Differential Diagnosis of Cutaneous Metastases

Cutaneous metastases, also known as metastatic tumors to the skin, are a diagnostic challenge for pathologists and dermatologists. These metastases can be difficult to distinguish from primary cutaneous malignant neoplasms, which can lead to delayed or incorrect diagnosis.

Common Differential Diagnoses

The following conditions should be considered in the differential diagnosis of cutaneous metastases:

• Primary Cutaneous Malignant Neoplasms: Adenocarcinoma, squamous cell carcinoma, and basal cell carcinoma are common primary cutaneous malignancies that can mimic metastatic tumors.
• Radiation-Induced Dermatitis: This condition can present with skin lesions similar to those seen in cutaneous metastases.
• Granulomatous Dermatoses: Conditions such as granuloma annulare, necrobiosis lipoidica, and granuloma faciale can be mistaken for cutaneous metastases.
• Ectopic Mammary Carcinoma: This rare condition presents with skin lesions that can mimic breast cancer metastasis to the skin.

Clinical Presentation

Cutaneous metastases can present in various ways, including:

• Single or Multiple Lesions: Metastatic tumors can appear as single or multiple lesions on the skin.
• Variety of Skin Types: Cutaneous metastases can occur on any type of skin, including normal-appearing skin.
• Painful or Pain-Free: The lesions can be painful or pain-free.

Importance of Immunohistochemical Staining

Immunohistochemical staining methods continue to evolve and are crucial in the diagnosis of cutaneous metastases. These methods can help identify the primary site of the tumor and confirm the presence of metastatic disease.

References:

• [1] Wang KL, 2024 - Cutaneous metastases from internal malignancies represent a wide spectrum of clinical appearances.
• [2] Iliescu CA, 2024 - Cutaneous metastases from clear cell renal carcinoma are uncommon and often indicate a poor prognosis.
• [3] Haddad CJ, (no date) - Primary cutaneous lymphomas, Merkel cell carcinoma, Kaposi sarcoma, adnexal tumors, and metastatic cancers to the skin are included in this review.
• [4] Mendes Serrao E, 2022 - Metastases to the scalp can be clinically silent and occur years after initial diagnosis and treatment.
• [5] Abou Shahla W, 2024 - Differential diagnosis of cutaneous metastasis includes radiation-induced dermatitis, granulomatous dermatoses, and primary cutaneous malignant neoplasms.
• [6] Salem I, 2023 - The differential diagnosis of the skin tumor in this case included primary ectopic mammary carcinoma and cutaneous metastatic breast cancer.