Image in medicine
Skin lesions in a lung cancer patient.
A. Vrancken1, E. Verbeken2, K. Nackaerts1
1
KU Leuven, University of Leuven, University Hospitals Leuven, Department of Respiratory
Diseases, Respiratory Oncology Unit, Leuven, Belgium.
2
KU Leuven, University of Leuven, University Hospitals Leuven, Department of Pathology,
Leuven, Belgium.
Corresponding author:
Dr. Anniek Vrancken
University Hospitals Leuven
Department of Respiratory Diseases/Respiratory Oncology Unit
Herestraat 49
3000 Leuven
Belgium
Conflicts of interest:
None to declare
Keywords:
Lung Cancer, Skin, Metastases, Lupus Erythematosus, Sweet Syndrome
Case presentation
A 50-year-old woman with a history of systemic lupus erythematosus was diagnosed with
advanced adenocarcinoma of the right lung. Because of tumour progression 8 months after
diagnosis, further chemotherapy with vinorelbine was started. She then presented in our
emergency room with fever (38°C) and skin rash around the port catheter. At physical
examination, papules and plaques were localized on the right side of the neckline (Fig. 1).
Laboratory analysis only revealed elevated C-reactive protein (120 mg/l). An ultrasound of
the neck didn’t reveal subcutaneous collections. The dermatologist’s differential diagnosis
included cellulitis, lupus erythematosus or Sweet syndrome. Initially, the patient refused skin
biopsy. Antibiotics and topical corticosteroids were empirically started. Two weeks later she
presented with increased skin lesions, spreading to the left neck region (Fig. 2). Skin biopsy
demonstrated intradermal tumoural proliferation, compatible with cutaneous metastasis of her
lung adenocarcinoma (Fig. 3).
Discussion
The skin is a rare metastatic site of internal malignancies, although lung and breast cancer
have the highest incidence of cutaneous metastasis formation. Approximately 1-12% of
patients with lung cancer may develop cutaneous metastases.1 Diagnosis of skin metastasis is
made either in a known lung cancer patient or can be the presenting symptom. Skin
metastases are nodular, mobile, non-ulcerated, with varying size (0.5-5.5 cm) and ipsilateral
to the primary cancer site.2 Most common location is the thorax, followed by the back and
abdomen. The most common detected histological tumour type is adenocarcinoma followed
by squamous cell carcinoma,1-3 however, without significant difference. Prognosis of skin
metastases in lung cancer is very poor due to its association with advanced disease. Median
survival doesn’t exceed 4 months.2,4
In conclusion, biopsy should be considered when nodular skin lesions appear in lung cancer
patients, but also in patients with a history of lung cancer or in non-cancer patients who
smoke.
References
1. Hidaka T, Ishii Y, Kitamura S. Clinical features of skin metastasis from lung cancer.
Intern Med 1996;35:459-462.
2. Dhambri S, Zendah I, Ayadi-Kaddour A, Adouni O, El Mezni F. Cutaneous metastasis
of lung carcinoma: a retrospective study of 12 cases. J Eur Acad Dermatol Venereol
2011;25(6):722-726.
3. Terashima
T,
Kanazawa
M.
Lung
cancer
with
skin
metastasis.
Chest
1994;106(5):1448-1450.
4. Song Z, Lin B, Shao L, Zhang Y. Cutaneous metastasis as an initial presentation in
advanced non-small cell lung cancer and its poor survival prognosis. J Cancer Res
Clin Oncol 2012;138:1613-1617.
Figure legends
Figure 1:
Erythematous confluent papules and plaques localized on the right side of the neckline.
Figure 2:
Persistent confluent papules and plaques with increased infiltration.
Figure 3:
Overview of the skin biopsy shows cytokeratin positive tumor cells within the dermis
(original magnification X 50).
Figure 1
Figure 2
Figure 3