Presentation
A 90-year-old woman develops four painless lumps in the skin of the right arm and trunk. 16 years before, she was diagnosed with a stage 1 carcinoma of the left breast (pT2 pN0 HER2 positive breast cancer). She underwent a lower-outer left quadrantectomy and axillary lymph node dissection, followed by radiotherapy and hormonal therapy. Two years before the patient had a metastatic femoral fracture treated by intramedullary nailing.
Patient Data
The cutaneous nodules are less than 1 cm, firm, round, mobile, non-painful and the skin over them is normal.
Ultrasound shows a well-defined, solid homogeneous, hypoechoic, subcutaneous nodule; color Doppler imaging confirms the absence of vascular flow within the mass.
Case Discussion
One of these was removed for histological diagnosis, that shown a cutaneous metastasis of breast cancer. No further metastases are detected on chest x-ray, bone scan or liver ultrasound.
Skin metastasis of solid tumors accounts for 2% of all skin tumors. For the high incidence of breast cancer in the female population, cutaneous metastases of breast cancer are the most frequently cutaneous metastases encountered in clinical practice, with a rate of 30%.
They frequently are the first sign of extranodal metastatic disease. Cutaneous metastases of breast cancer can occur either by lymphatic or hematogenic spread and are most commonly seen in the head, neck regions and trunk.
Other cancers that have a high propensity to metastasize to the skin include melanoma (45% of cutaneous metastasis cases), nasal sinuses (20%), larynx (16%), and oral cavity (12%).
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