Nodular Cutaneous Metastasis
Metastatic tumours of the skin are rarely seen skin tumours that can appear before or at any time after the diagnosis of an internal malignancy. Studies report that metastatic tumours of the skin are observed in 0.7% to 10.4% of cases with internal malignancy. In patients not yet diagnosed with a primary internal malignancy, metastatic skin involvement is very important because it is visible and can herald the main malignant tumour. However, skin metastases, which are often seen to appear as nodules or papules, are sometimes regarded as trivial by the patient or even by health professionals and are not taken seriously, and when histopathological examination is not carried out, the diagnosis is delayed.
When patients already diagnosed with an internal malignancy see a dermatologist, the possibility of skin metastasis is particularly kept in mind; however, because the clinical features of these rare tumours are not well known, a provisional diagnosis of skin metastasis may be missed in patients who have not been diagnosed with a malignancy.
Carcinoma Erysipeloides
Carcinoma erysipeloides was first described in 1931 by Rasch as an erysipelas-like picture with sharply demarcated erythema, warmth and induration. Because CE is most often associated with breast carcinoma, it was previously also called 'inflammatory carcinoma of the breast', but associations with malignancies of organs such as the lung, stomach, thyroid, prostate and larynx, and with melanoma, have since been reported.
The lesions mostly form over the affected breast as a result of blockage, through invasion by tumour cells, of the superficial and deep lymphatics or lymph nodes that drain the area. Although it is classified among skin metastases in the literature, it should be remembered that CE is an invasive carcinoma, because the tumour cells reach the skin by contiguous spread.
In the English-language literature, a total of 12 cases of CE have been described, caused by four breast carcinomas, four gastric adenocarcinomas, two prostate carcinomas, one thyroid carcinoma and one lung carcinoma. In the Turkish literature, a total of six cases of CE have been reported, associated with three breast carcinomas, one gastric adenocarcinoma, one laryngeal carcinoma and one malignant melanoma.
Sister Mary Joseph Nodule
A Sister Mary Joseph nodule is an umbilical metastasis seen in cancer patients. Several different routes have been implicated in the formation of umbilical metastasis, and the primary focus is usually located in the abdomen or pelvis. The prognosis for these patients is very poor.
A skin metastasis located in the umbilicus is defined as a ‘Sister Mary Joseph nodule’ (SMJN). Sister Mary Joseph Dempsey worked as William J. Mayo’s surgical assistant at St. Mary’s Hospital in Minnesota between 1890 and 1915, and the first article on this metastatic nodule was published in 1928. The primary focus is most often the intra-abdominal and pelvic organs, but umbilical metastasis of haematological malignancies has also rarely been reported. A Sister Mary Joseph nodule is a poor prognostic indicator in cancer patients, and survival from the time of diagnosis in untreated patients has been reported as 2 to 11 months.
Paget’s Disease
Paget’s disease was first described by the English doctor Sir James Paget. Dr Paget was a scientist who lived between 1814 and 1899. He was the first to describe three diseases that are named after him. Paget’s disease of the breast is a type of breast cancer, either invasive breast cancer or intraductal carcinoma in situ, that arises in the nipple and the brown area around it.
In about half of patients a palpable lump is found in the breast, while in the other half there is no lump that can be detected in the breast. It is less common than other types of cancer. It is most often seen between the ages of 55 and 60 and usually occurs in one breast. Paget’s disease most often produces an eczema-like, ulcerated appearance of the nipple.
At first there is redness right on the nipple, which later begins to spread to the surrounding brown skin (the areola).
This condition does not improve with eczema medicines and continues to progress; as it progresses, the patient may develop pain, burning and sometimes bloody discharge in that area. Although the cause of Paget’s disease is not fully known, the risk is considerably higher in some women. Paget’s disease may be more common in women who have never had children, had children late, started menstruating early and reached menopause late, and in women with a family history of breast cancer.