Dermatologic Manifestations of Metastatic Carcinomas Treatment & Management

  • Author: Thomas N Helm, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 26, 2012
 

Medical Care

  • Effective treatment depends on treatment of the underlying tumor. Palliative care is given if lesions are asymptomatic and the primary cancer is untreatable. This care includes keeping lesions clean and dry and debriding the lesions if they are bleeding or crusted. Hydrocolloid dressings may be used to help prevent secondary infection.
  • Studies indicate that imiquimod 5% cream (Aldara) may lead to regression of metastasis in some cases of melanoma.
  • Liquid nitrogen cryotherapy, photodynamic therapy, and conventional surgery also may be useful for palliation of skin metastasis.
  • Short wavelength radiation therapy may be helpful to provide symptomatic relief for painful lesions, using superficial electron beam therapy. Cryotherapy with temperature probe control, carbon dioxide laser therapy,[9, 10] electrochemotherapy,[11] and other treatment approaches may also be of value. Pulsed dye laser may be of value to reduce blood flow to highly vascularized metastases. Intralesional chemotherapy and cytokines can be helpful, and topical retinoids or immune modulators, such as imiquimod, offer promise in select cases.
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Surgical Care

In many cases, cutaneous metastasis can cause disfigurement or social embarrassment, or they can diminish the quality of the patient's life. Excision and removal of metastasis may be warranted to enhance the patient's quality of life, but excision of select metastases does little to increase survival. Simple excision is usually the treatment of choice.

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Contributor Information and Disclosures
Author

Thomas N Helm, MD  Clinical Professor of Dermatology and Pathology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Director, Buffalo Medical Group Dermatopathology Laboratory

Thomas N Helm, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas C Lee, MD  Intern, Department of Internal Medicine, New York University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: a meta-analysis of data. South Med J. Feb 2003;96(2):164-7. [Medline].

  2. 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. Sep 2009;35(9):1355-63. [Medline].

  3. Sharma S, Kotru M, Yadav A, Chugh M, Chawla A, Makhija M. Role of fine-needle aspiration cytology in evaluation of cutaneous metastases. Diagn Cytopathol. Dec 2009;37(12):876-80. [Medline].

  4. Bhargava R, Dabbs DJ. Immunohistology of Metastatic Carcinomas of Unknown Primary. In: Dabbs, DJ, ed. Diagnostic Immunohistochemistry: theranostic and genomic applications. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2010:206-55.

  5. Krug B, Crott R, Lonneux M, Baurain JF, Pirson AS, Vander Borght T. Role of PET in the initial staging of cutaneous malignant melanoma: systematic review. Radiology. Dec 2008;249(3):836-44. [Medline].

  6. Chung MH, Gupta RK, Essner R, Ye W, Yee R, Morton DL. Serum TA90 immune complex assay can predict outcome after resection of thick (> or =4 mm) primary melanoma and sentinel lymphadenectomy. Ann Surg Oncol. Mar 2002;9(2):120-6. [Medline].

  7. Cassarino DS, Cabral ES, Kartha RV, Swetter SM. Primary dermal melanoma: distinct immunohistochemical findings and clinical outcome compared with nodular and metastatic melanoma. Arch Dermatol. Jan 2008;144(1):49-56. [Medline].

  8. Requena L, Sangueza M, Sangueza OP, Kutzner H. Pigmented mammary Paget disease and pigmented epidermotropic metastases from breast carcinoma. Am J Dermatopathol. Jun 2002;24(3):189-98. [Medline].

  9. Hill S, Thomas JM. Use of the carbon dioxide laser to manage cutaneous metastases from malignant melanoma. Br J Surg. Apr 1996;83(4):509-12. [Medline].

  10. Lingam MK, McKay AJ. Carbon dioxide laser ablation as an alternative treatment for cutaneous metastases from malignant melanoma. Br J Surg. Oct 1995;82(10):1346-8. [Medline].

  11. Kubota Y, Mir LM, Nakada T, Sasagawa I, Suzuki H, Aoyama N. Successful treatment of metastatic skin lesions with electrochemotherapy. J Urol. Oct 1998;160(4):1426. [Medline].

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  17. Schwartz RA. Metastatic cancer of the skin. In: Skin Cancer Recognition and Management. New York, NY: Springer-Verlag; 1998:185-93.

  18. Spencer PS, Helm TN. Skin metastases in cancer patients. Cutis. Feb 1987;39(2):119-21. [Medline].

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  22. Zalla MJ, Roenigk RK. Metastatic carcinoma. In: Maloney M, Helm KF. Surgical Dermatopathology. Malden, Mass: Blackwell; 1999:389-436.

 
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