Cutaneous Metastases - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Cutaneous metastasis, often known as "metastases," is the formation of cancer cells in the skin that have spread from an internal tumor. The majority of the time, cutaneous metastasis appears late in the course of the disease and after the initial diagnosis of the original internal malignancy (such as breast cancer and lung cancer). Rarely, skin metastases may develop concurrently with or prior to the discovery of the original malignancy and may serve as a catalyst for a complete investigation.

Cutaneous metastasis from skin cancer, typically melanoma, is another possibility. Metastases, or "secondary" growths, are brought on by the original or "primary" melanoma and develop in nearby or distant skin sites as well as other tissues, including the lungs or brain.

How Does Cutaneous Metastasis Occur?

When cancerous cells separate from a primary tumor and go to the skin through the bloodstream or lymphatic system, this is known as cutaneous metastasis. Although skin metastasis can occur in the majority of malignant tumors (cancer), some are more likely to do so than others. The likelihood of the skin being affected is fairly significant when the following malignancies have metastasized.

• Melanoma (a type of skin cancer): 45 percent probability of developing cutaneous metastasis (seven to ten percent overall chance; however, only 15 to 20 percent of melanomas metastasize).

• Thirty percent have breast cancer.

• Twenty percent of nasal sinus malignancies.

• Sixteen percent of cases of larynx cancer.

• Twelve percent of cases of oral cancer.

Patients with a primary malignant tumor have a skin metastatic rate that ranges from three to ten percent.

A person's age and sex also seem to affect how often certain primary malignancies spread to the skin. Unknown factors may be at play. About 70 percent of cutaneous metastases in women begin in the breast. Men are more likely than women to develop cutaneous metastases from the lung (24 percent), colon (19 percent), skin (13 percent from melanoma), or oral cavity (12 percent).

What Are the Signs and Symptoms of Cutaneous Metastases?

The majority of cutaneous metastasis happens close to a primary tumor on the body. A firm, round, or oval, movable, painless nodule is frequently the earliest evidence of metastasis. The nodules range in size from small lesions to huge tumors and have a rubbery, firm, or hard texture. These could be skin-colored, red, or in the case of melanoma, blue or black, depending on the type. Sometimes, several nodules develop suddenly. Skin metastases have the potential to deteriorate and ulcerate through the skin. Particular patterns consist of the following:

• Carcinoma Erysipeloides: It is a clearly defined red patch brought on by the local spread of a primary malignancy that obstructs lymphatic blood vessels in the nearby skin.

• En Cuirasse or Sclerodermoid Carcinoma: It is an indurated fibrous plaque resembling scars brought on by cancer cells invading skin collagen.

• Carcinoma telangiectodes: It is a red spot with numerous lymphatic or blood vessels (like lymphangiomas) or blood vessels (telangiectasia).

The characteristics of cutaneous metastasis vary depending on where the initial tumor was located. The following are the different characteristic features of the cutaneous metastases based on the organ of the cancer origin:

1. Breast:

• The chest and abdomen are where metastases most frequently occur.

• The scalp, neck, upper extremities, and back are less frequent locations.

• Some patients may experience the skin becoming a stiff scar-like region. Hair loss (alopecia neoplastica) may result if this happens on the scalp.

• Inflammatory plaques with a distinct elevated edge may be seen as lesions (carcinoma erysipeloides).

2. Lung:

• The chest, abdomen, and back are the most frequent areas.

• Skin lesions that are hard and reddish abruptly develop.

• When nodules develop on the chest, they frequently follow the intercostal arteries.

3. Melanoma:

• The chest, extremities, and back are the sites of metastases in men.

• Lower extremity metastases are more frequent in women.

4. Colon and the stomach:

• The pelvis and the abdomen are frequent areas.

• The sister mary joseph nodule, which develops at the umbilicus, is a marker of advanced colorectal cancer.

How Is Cutaneous Metastasis Diagnosed?

Imaging tests, histological examinations, and clinical evaluation are frequently combined to make the diagnosis of cutaneous metastases. These are the main diagnostic techniques:

• Clinical Review:

  • Dermatological Evaluation: The skin is thoroughly examined physically to look for any abnormal lesions, changes in texture, color, or shape, and palpable lumps.

  • Medical History Evaluation: In order to rule out the likelihood of cutaneous metastases, the patient's medical history is examined, including any prior cancer diagnoses and treatments.

• Imaging Research:

  • Ultrasound: Used to examine the characteristics of skin lesions, gauge their level of involvement, and spot any underlying masses.

  • Computed Tomography (CT) Scan: An accurate cross-sectional image of the body is provided by a computed tomography (CT) scan, which can be used to find primary tumors and determine the severity of the disease, including whether or not distant metastases or lymph node involvement are present.

  • Magnetic Resonance Imaging (MRI): In some circumstances, magnetic resonance imaging (MRI) is used to assess the involvement of deeper tissues or to further analyze lesions.

  • Positron Emission Tomography (PET) Scan: A nuclear imaging technique for locating potential metastatic sites and detecting metabolic activity in tissues.

• Skin Biopsies: A skin biopsy is the gold standard for identifying cutaneous metastases. The damaged skin is isolated in a tiny sample and sent for histological examination.

• Dermatopathologist Assessment: Under a microscope, the skin biopsy sample is analyzed to detect the presence of cancer cells, evaluate the histological features, and contrast them with the primary tumor or known metastatic sites.

• Immunohistochemistry (IHC): In order to locate the primary tumor site or confirm metastasis from a previously identified primary tumor, specific antibodies are employed to recognize markers on the cancer cells.

What Are the Options for Treating Cutaneous Metastasis?

Treatment must be given to the primary tumor at the root. However, the original malignancy is typically extensive and may not be curable in cases where skin metastasis has occurred. Palliative treatment is provided in this situation, which includes keeping lesions dry and clean. Lesions that bleed or crust can be debrided. Other treatments that could be beneficial include:

• In some melanoma cases, imiquimod cream may cause metastases to retreat.

• Cryotherapy (use of extreme cold to free and remove the abnormal tissue) using liquid nitrogen.

• Photodynamic (usage of light source and light-sensitive medicines to destroy the abnormal cells) treatment.

• Excision (removal of the abnormal tissue).

• Laser therapy with carbon dioxide.

• Laser therapy with pulsed dye.

• Chemotherapy and cytokines (proteins that help in reducing inflammation) for topical and intralesional use.

• Bleomycin or Cisplatin are drugs that are injected into tumors and are made more effective by a process called electrochemotherapy.

Cutaneous metastasis frequently results in deformity and discomfort. Simple excision of skin lesions may improve the patient's quality of life, but it has little impact on the eventual result, which is determined by the main cancer.

Conclusion

Cutaneous metastasis is an advanced stage of cancer that has major effects on the prognosis and course of treatment for the patient. Optimizing outcomes depends on early discovery, precise diagnosis, and quick multidisciplinary care. The understanding of this complex phenomenon will be further improved by ongoing research and developments in cancer treatment, which will result in better diagnostic instruments and therapeutic alternatives for people with cutaneous metastases.