Palliative Treatment
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.Topical retinoids offer promise in select cases, and studies indicate that the immune modulator imiquimod 5% cream (Aldara) may lead to regression of metastases in some patients with melanoma. Photodynamic therapy also may be useful for palliation of skin metastases.
Short-wavelength radiation therapy may be helpful for providing symptomatic relief from painful lesions, using superficial electron beam therapy. Carbon dioxide laser therapy, [16, 17] electrochemotherapy, [18] liquid nitrogen cryotherapy with temperature probe control, and other treatment approaches may also be of value.
Pulsed dye laser treatment, which can reduce blood flow to highly vascularized lesions, may be of value. Intralesional chemotherapy and cytokines can also be helpful.
Medical camouflage with cosmetics (eg, Dermablend) may be of value to disguise visible metastases for cosmetic purposes.
Surgical Care
In many cases, cutaneous metastases can cause disfigurement or social embarrassment, or they can diminish the quality of the patient's life. Surgical approaches are generally the most effective as a temporizing measure for cutaneous metastases. Excision and removal of metastases 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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Low-power view of breast cancer metastasis with surrounding fibrosis.
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Breast cancer metastasis with hyperchromatic cells extending between thickened collagen bundles. Dilated lymphatics are noted.
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Alopecia neoplastica due to metastatic breast cancer.
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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.
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Breast cancer with an Indian file pattern of metastasis.
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A well-circumscribed metastasis of renal cell carcinoma is surrounded by compressed collagen, which is indicative of rapid growth.
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Pleomorphic clear cells with prominent vasculature are characteristic of metastatic renal cell carcinoma.
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Metastatic squamous cell cancer typically does not involve the epidermis, allowing for differentiation of metastases from primary cutaneous squamous cell cancer.
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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.
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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.
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High-power examination reveals neoplastic epithelioid cells within dilated lymphatics. Hematoxylin and eosin‒stained sections; original magnification, 400x.
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Inflammatory breast carcinoma.
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High-powered microscopic examination reveals tubules composed of clear cells, hemorrhage, and a prominent vascular pattern characteristic of metastatic renal cell carcinoma.
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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.
