Diagnostic Considerations

Conditions to consider in the diagnosis of dermatologic metastases include the following:

Branchial cleft cyst
Cellulitis
Dermatofibroma
Herpes zoster
Pyogenic granuloma (lobular capillary hemangioma)

Workup

Vichapat V, Garmo H, Holmberg L, Fentiman IS, Tutt A, Gillett C, et al. Patterns of metastasis in women with metachronous contralateral breast cancer. Br J Cancer. 2012 Jul 10. 107(2):221-3. [QxMD MEDLINE Link]. [Full Text].
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. 2008 Jan. 144(1):49-56. [QxMD MEDLINE Link].
Requena L, Sangueza M, Sangueza OP, Kutzner H. Pigmented mammary Paget disease and pigmented epidermotropic metastases from breast carcinoma. Am J Dermatopathol. 2002 Jun. 24(3):189-98. [QxMD MEDLINE Link].
Mahalingam M, Nguyen LP, Richards JE, Muzikansky A, Hoang MP. The diagnostic utility of immunohistochemistry in distinguishing primary skin adnexal carcinomas from metastatic adenocarcinoma to skin: an immunohistochemical reappraisal using cytokeratin 15, nestin, p63, D2-40, and calretinin. Mod Pathol. 2010 May. 23(5):713-9. [QxMD MEDLINE Link].
Lee JJ, Mochel MC, Piris A, Boussahmain C, Mahalingam M, Hoang MP. p40 exhibits better specificity than p63 in distinguishing primary skin adnexal carcinomas from cutaneous metastases. Hum Pathol. 2014 May. 45 (5):1078-83. [QxMD MEDLINE Link].
Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: a meta-analysis of data. South Med J. 2003 Feb. 96(2):164-7. [QxMD MEDLINE Link].
Wong CY, Helm MA, Helm TN, Zeitouni N. Patterns of skin metastases: a review of 25 years' experience at a single cancer center. Int J Dermatol. 2014 Jan. 53(1):56-60. [QxMD MEDLINE Link].
Song Z, Lin B, Shao L, Zhang Y. Cutaneous metastasis as a initial presentation in advanced non-small cell lung cancer and its poor survival prognosis. J Cancer Res Clin Oncol. 2012 May 13. [QxMD MEDLINE Link].
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. 2002 Mar. 9(2):120-6. [QxMD MEDLINE Link].
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. 2009 Sep. 35(9):1355-63. [QxMD MEDLINE Link].
Chernoff KA, Marghoob AA, Lacouture ME, Deng L, Busam KJ, Myskowski PL. Dermoscopic findings in cutaneous metastases. JAMA Dermatol. 2014 Apr. 150 (4):429-33. [QxMD MEDLINE Link].
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. 2008 Dec. 249(3):836-44. [QxMD MEDLINE Link].
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Heath MS, Slaught C, Ortega-Loayza AG, Mengden S. Carcinoma Erysipeloides From Metastatic Cutaneous Squamous Cell Carcinoma Initially Mistaken for Intralymphatic Histiocytosis. Am J Dermatopathol. 2019 Jul. 41 (7):522-525. [QxMD MEDLINE Link].
Bhargava R, Dabbs DJ. Immunohistology of Metastatic Carcinomas of Unknown Primary. Dabbs, DJ, ed. Diagnostic Immunohistochemistry: theranostic and genomic applications. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2010. 206-55.
Hill S, Thomas JM. Use of the carbon dioxide laser to manage cutaneous metastases from malignant melanoma. Br J Surg. 1996 Apr. 83(4):509-12. [QxMD MEDLINE Link].
Lingam MK, McKay AJ. Carbon dioxide laser ablation as an alternative treatment for cutaneous metastases from malignant melanoma. Br J Surg. 1995 Oct. 82(10):1346-8. [QxMD MEDLINE Link].
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Media Gallery

Low-power view of breast cancer metastasis with surrounding fibrosis.
Breast cancer metastasis with hyperchromatic cells extending between thickened collagen bundles. Dilated lymphatics are noted.
Alopecia neoplastica due to metastatic breast cancer.
Close-up view of patient with alopecia neoplastica due to metastatic breast cancer shows telangiectases and nodularity. The plaque was markedly indurated on palpation; in contrast, patients with alopecia areata would exhibit normal skin texture.
Breast cancer with an Indian file pattern of metastasis.
A well-circumscribed metastasis of renal cell carcinoma is surrounded by compressed collagen, which is indicative of rapid growth.
Pleomorphic clear cells with prominent vasculature are characteristic of metastatic renal cell carcinoma.
Metastatic squamous cell cancer typically does not involve the epidermis, allowing for differentiation of metastases from primary cutaneous squamous cell cancer.
Biopsy of metastatic melanoma reveals a well-circumscribed tumor in the dermis with no connection with the overlying epidermis. Hematoxylin and eosin‒stained sections; original magnification 20x.
High-powered examination reveals a nest of atypical melanocytes with enlarged and pleomorphic nuclei. Melan-A and S-100 stains were positive and helped confirm the diagnosis. Hematoxylin and eosin‒stained sections; original magnification 200x.
High-power examination reveals neoplastic epithelioid cells within dilated lymphatics. Hematoxylin and eosin‒stained sections; original magnification, 400x.
Inflammatory breast carcinoma.
High-powered microscopic examination reveals tubules composed of clear cells, hemorrhage, and a prominent vascular pattern characteristic of metastatic renal cell carcinoma.
Biopsy of a nodule on the scalp revealed a precocious metastasis from renal cell carcinoma. Cutaneous metastases are sometimes the first presentation of internal disease. Histologic examination reveals a spherical tumor in the dermis with no connection to the overlying epidermis. Hematoxylin and eosin‒stained sections; original magnification 20x.

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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, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Thomas C Lee, MD Associated Gastroenterologists of Central New York, St Joseph’s Hospital

Thomas C Lee, MD is a member of the following medical societies: American College of Gastroenterology, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Matthew F Helm, MD Assistant Professor of Dermatology, Pennsylvania State University College of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.