1.Cutaneous metastasis as a diagnostic prelude in a 48-year-old female
Nagatoshi M. Ebisawa ; Isabel G. Palabyab‑Imperial ; Leilani R. Senador ; Luella Joy A. Escueta‑Alcos
Journal of the Philippine Dermatological Society 2023;32(2):107-110
Cutaneous metastasis (CM) describes the spread of a distant primary tumor into the skin. The overall
incidence of CM ranges from 5% to 10% with breast cancer having the highest rate in women. CM of breast
carcinoma origin may manifest as erysipelas-like erythema on the chest, having distinct raised borders and
edema due to lymphatic obstruction termed as carcinoma erysipeloides. In most cases, CM is recognized
after the initial diagnosis of primary internal malignancy. However, in 0.6–1% of cases, CM served as the
first presenting sign of malignancy. A 48-year-old female presented with multiple, erythematous patches,
and plaques with clear-cut raised margins, some topped with violaceous pinpoint papules and nodules
on the chest, abdomen, and back. No palpable breast mass was appreciated. There was noted nipple
retraction and axillary lymphadenopathy. A 4-mm skin punch biopsy revealed nests of large pleomorphic
cells on the papillary dermis admixed with mitotic figures and attempts of ductal formation. CK7 and CEA
were positive. Results of ultrasonography and mammogram were highly suspicious of malignancy. Core
needle biopsy of the breast mass revealed an invasive ductal carcinoma. In the context of an eczematous
presentation on the chest area without palpable nodules or mass on breast examination, a diagnostic
challenge is expected. Interestingly, our patient represents a small group of CM having cutaneous lesions
as their primary manifestation. A high index of suspicion supplemented with proper clinicopathologic and
radiologic correlation is crucial for the diagnosis of CM. A multidisciplinary referral is required for adequate
management and overall survival rate.
Breast Neoplasms