Metastatic Gastric Adenocarcinoma Presenting as a Solitary Plaque on the Palm

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Abstract

Cutaneous metastases from gastric adenocarcinoma are extremely rare. When present, metastasis typically signifies disseminated disease with a poor prognosis. We report a case of an 80-year-old male with gastric cancer who presented with a single, erythematous plaque on the left palm, a very rare site for skin metastasis. Results of a skin biopsy demonstrated that the cutaneous metastasis originated from the stomach. This report emphasized the need for appropriate investigation into newly appearing, unusual, or persistent skin lesions.

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Most cited references 21

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Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients.

D P Lookingbill, N Spangler, K F Helm (1993)

Most previous studies have found that cutaneous metastases occur infrequently and are rarely present at the time the cancer is initially diagnosed. We studied patients with metastatic cancer to determine the overall frequency of skin metastases, the frequency that these were the first sign of extranodal disease, and the clinical and histologic features of the cutaneous lesions. A 10-year period of tumor registry files was searched for patients with metastatic carcinoma and melanoma. For patients with skin metastases, medical records and pathology reports were also examined. Of 4020 patients with metastatic disease, 420 (10%) had cutaneous metastases; in 306 of them the skin metastases were the first sign of extranodal metastatic Breast cancer and melanoma were the most common. Nodules were the most frequent clinical presentation, although inflammatory, cicatricial, and bullous lesions were also noted. Incisional metastases were common. Histologic findings most frequently revealed adenocarcinoma that was sometimes suggestive of the site of origin. After recognition of skin metastases, mean patient survival ranged from 1 to 34 months depending on tumor type. Cutaneous metastases are not uncommon and frequently are the first sign of extranodal metastatic disease, particularly in patients with melanoma, breast cancer, or mucosal cancers of the head and neck.

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Cutaneous metastatic disease.

Allison R. Schwartz (1995)

The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.

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Rates of cutaneous metastases from different internal malignancies: experience from a Taiwanese medical center.

Stephen Hu, Gwo-Shing Chen, Ching-Shuang Wu … (2009)

Previous reports regarding the rates at which various internal tumors metastasize to the skin have been limited and have only included the Caucasian population. Moreover, the mechanisms that predispose certain internal malignancies to metastasize to the skin have rarely been discussed in the scientific literature. We determined the frequencies with which various internal malignancies metastasize to the skin in patients from a Taiwanese medical center. We also evaluated whether expressions of chemokine receptors CCR10 and CXCR4 by tumor cells correlate with cutaneous metastatic ability. Clinical records from Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, during 20 years (1986-2006) were reviewed and cases of biopsy-proven primary internal malignancies and cutaneous metastases were identified. Immunohistochemical staining with antibodies to CCR10 and CXCR4 was performed on a selected number of internal malignancies with and without skin metastases. From 12,146 patients with internal malignancies, we found 124 cases (1.02%) with cutaneous metastases. The highest rates of skin metastases were found to occur from carcinoma of the breast, followed by the lung, oral mucosa, colon and rectum, stomach, and esophagus. However, the rate of cutaneous metastasis from breast cancer was much lower compared with previous studies involving Caucasians. In general, adenocarcinomas gave rise to cutaneous metastases at a higher frequency compared with other histologic subtypes. In addition, the expressions of CCR10 and CXCR4 by tumor cells did not correlate well with the presence or absence of skin metastases. This study is retrospective in nature. Different internal malignancies metastasize to the skin with different frequencies, and the rates at which different malignancies metastasize to cutaneous sites differ between the Taiwanese and Caucasian populations. The mechanisms responsible for the cutaneous metastatic ability of certain malignancies likely involve factors other than chemokine receptors CCR10 and CXCR4, because their expressions by tumor cells are neither necessary nor sufficient for the formation of skin metastases.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Dermatol

Journal ID (publisher-id): AD

Title: Annals of Dermatology

Publisher: Korean Dermatological Association; The Korean Society for Investigative Dermatology

ISSN (Print): 1013-9087

ISSN (Electronic): 2005-3894

Publication date (Print): October 2011

Publication date (Electronic): 31 October 2011

Volume: 23

Issue: Suppl 2

Pages: S205-S207

Affiliations

Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.

Author notes

Corresponding author: Kui Young Park, M.D., Department of Dermatology, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea. Tel: 82-2-6299-1525, Fax: 82-2-823-1049, momo920@ 123456hanmail.net

Article

DOI: 10.5021/ad.2011.23.S2.S205

PMC ID: 3229066

PubMed ID: 22148051

SO-VID: f25dbf4f-902d-4503-9875-132a37b7b67e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 09 February 2011

Date revision received : 26 April 2011

Date accepted : 01 May 2011

Metastatic Gastric Adenocarcinoma Presenting as a Solitary Plaque on the Palm

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Abstract

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Karger: Dermatology

Most cited references 21

Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients.

Cutaneous metastatic disease.

Rates of cutaneous metastases from different internal malignancies: experience from a Taiwanese medical center.

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