Dermal metastases from a visceral primary.A 61-year-old man with a history of right tongue-base cancer, which was treated approximately 2 years earlier with primary radiotherapy and an interval neck dissection, came to the office with biopsy-proven dermal metastases (figure). Panendoscopy with directed biopsies were negative for malignancy. Computed tomography of the neck confirmed that there was no contiguous involvement of any visceral structures with the overlying overlying suffocation of piglets by the sow. The piglets may be weak from illness or malnutrition, the sow may be clumsy or ill, the pen may be inadequate in size or poorly designed so that piglets cannot escape. skin. The patient underwent a salvage surgical resection followed by radiation boosts with implant therapy. [FIGURE OMITTED] In most cases, cutaneous involvement is the result of a direct extension of extranodal carcinoma into the dermis dermis: see skin. and the dermal lymphatics. This is not an uncommon finding in patients who do not respond to comprehensive treatments. However, metastases to the skin from a primary tumor in the visceral upper aerodigestive tract are quite rare, occurring in fewer than 2% of all visceral carcinomas. The scalp is the most common site of metastasis, but because examination of the scalp can be difficult, many of these lesions are diagnosed late. They usually present as multiple, firm, painless nodules. The presence of dermal metastases signals a poor prognosis because the lymphatic distribution in the skin is poorly understood. Wide local excision A wide local excision (WLE) is a surgical procedure to remove a small area of diseased or problematic tissue with a margin of normal tissue. This procedure is commonly performed on the breast and to skin lesions, but can be used on any area of the body. is often combined with adjuvant radiotherapy (i.e., external-beam or implant therapy) in an effort to eradicate tumor spread or palliate pal·li·ate v. To reduce the severity of; to relieve somewhat. palliate (pal´ēāt), v to reduce the severity of. symptoms. Suggested reading Marioni G, Doro D, Marino F, et al. Skin and eye: Uncommon sites of distant metastasis from tongue base squamous cell carcinoma squamous cell carcinoma n. A carcinoma that arises from squamous epithelium and is the most common form of skin cancer. Also called cancroid, epidermoid carcinoma. . Acta Otolaryngol 2003;123:1110-14. Navarro V, Ramon D, Calduch L, et al. Cutaneous metastasis of gastric adenocarcinoma: An unusual clinical presentation. Eur J Dermatol 2002;12:85-7. O'Donnell M, Whitaker D. Clinical evaluation of tumors of the skin. In: Thawley SE, Panje WR, Batsakis JG, Lindberg RD, eds. Comprehensive Management of Head and Neck Tumors. Vol. 2. Philadelphia: W.B. Saunders, 1999:1222-43. From the Head and Neck Cancer Center, Cedars-Sinai Medical Center Cedars-Sinai Medical Center is a world-renowned hospital located in Los Angeles, California. History Cedars-Sinai is the result of a merger in 1961 between two major Los Angeles hospitals, Cedars of Lebanon and Mount Sinai Home for the Incurables, with Steve Broidy as , Los Angeles, and the Department of Otolaryngology, Charles R. Drew University of Medicine and Science Drew is perhaps best known for its medical school designed to train physicians interested in working in urban environments, and founded in the response to the 1965 Watts riots to train minority doctors who would serve the poor of the South Los Angeles area. , Los Angeles. |
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