Case and Research Letter
Mask-like Metastases: Skin Metastases With a Very Poor Prognosis
Metástasis en antifaz, letálides de pronóstico nefasto
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Almodóvar-Real, R. Ruiz-Villaverde, J.C. Ruiz-Carrascosa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Díaz-Martínez" "email" => array:1 [ 0 => "migueldimar88@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Almodóvar-Real" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.C." "apellidos" => "Ruiz-Carrascosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis en antifaz, letálides de pronóstico nefasto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 534 "Ancho" => 950 "Tamanyo" => 68155 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hard, nonulcerated, erythematous and edematous plaques in the posterior cervical region.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Skin metastases are relatively rare, with an incidence of less than 1% among patients with visceral neoplasms.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> However, this rate increases to 24% in patients in whom the primary tumor is a breast cancer.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Clinical suspicion of metastases is usually based on the previous existence of a malignant primary tumor, although a third of skin metastases are discovered before the primary tumor.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Immunohistochemistry is a fundamental technique to establish the connection with the tumor of origin, and a number of diagnostic algorithms have been developed to identify this connection.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 55-year-old woman diagnosed with lobular breast carcinoma 15 years earlier. The patient was referred to our unit for a 1-year history of lesions that had arisen in the cervical region and that had extended to the upper third of the back and chest. Physical examination revealed hard, well-defined, edematous, erythematous papules and plaques in the posterior cervical region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and localized erythema of all 4 eyelids that infiltrated to the deeper planes and interfered with eye opening (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and closure (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">At the time of consultation, the patient's tumor was stage IVB, with uterine and gastric metastases that had been treated surgically. She had received multiple cycles of chemotherapy and radiotherapy, and continued on treatment with letrozole.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Histology of all the biopsies performed showed a dermal infiltrate of anaplastic cells arranged in cords (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The cells were positive for GCDFP-15 stain (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B), weakly positive for estrogen and progesterone receptors, negative for her2, and had a Ki67 proliferation index of 20%. A further cycle of chemotherapy was therefore administered with capecitabine, 2<span class="elsevierStyleHsp" style=""></span>g/d, but the patient died 2 months after starting the treatment.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Skin metastases are a very rare cause of eyelid tumors, accounting for less than 1% of malignant lesions of the eyelids.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Three clinical forms have been described: the nodular form, which is the most common and is characterized by painless subcutaneous nodules that can be confused clinically with a chalazion<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>; the diffuse inflammatory pattern, with a morpheaform appearance, as in our case; and the ulcerated form, in which histology reveals an infiltrate that extends beyond the dermis into the epidermis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The other structures of the orbit can be affected in any case,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> and imaging studies or ophthalmologic examination is therefore recommended. In our patient, we observed diffuse hyperechoic retroocular images that surrounded the optic nerves, suggestive of metastatic infiltration.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Recently, Martorell-Calatayud et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> reported 2 cases similar to ours, with bilateral eyelid metastases, and they gathered 11 previously published cases. In 9 of those cases, the primary neoplasm was a breast carcinoma and in the remaining 2 it was a gastric adenocarcinoma. Skin metastases affecting all 4 eyelids are very rare. They are associated with long-standing breast carcinoma and indicate systemic spread of the neoplastic disease. In addition to the previously mentioned gastric and uterine metastases, subsequent imaging studies in our patient revealed rectal involvement, peritoneal carcinomatosis, bone metastases, and metastases in the posterior region of the orbit.</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is currently thought that the increase in the incidence of metastases at these particular sites is due to the increased survival of cancer patients.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> In conclusion, in our patient with a 15-year history of malignant disease, the administration of multiple cycles of chemotherapy was interpreted as a factor that favored the appearance of this rare type of metastasis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz-Martínez MA, Almodóvar-Real A, Ruiz-Villaverde R, Ruiz-Carrascosa JC. Metástasis en antifaz, letálides de pronóstico nefasto. Actas Dermosifiliogr. 2016;107:263–264.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 534 "Ancho" => 950 "Tamanyo" => 68155 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hard, nonulcerated, erythematous and edematous plaques in the posterior cervical region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 428 "Ancho" => 1500 "Tamanyo" => 101922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythema and infiltration of the 4 eyelids interfered with eye opening (A) and closure (B).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1424 "Ancho" => 950 "Tamanyo" => 338376 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Histology showing a dermal infiltrate of cords of cells from a lobular breast adenocarcinoma. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20. B, Immunohistochemistry showing groups of cells positive for GCDFP-15, indicating an origin in breast tissue. Original magnification<span class="elsevierStyleHsp" style=""></span>×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin metastases in cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.S. Spencer" 1 => "T.N. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 7 | 13 |
| 2024 Octubre | 68 | 24 | 92 |
| 2024 Septiembre | 77 | 24 | 101 |
| 2024 Agosto | 104 | 57 | 161 |
| 2024 Julio | 72 | 30 | 102 |
| 2024 Junio | 70 | 34 | 104 |
| 2024 Mayo | 54 | 25 | 79 |
| 2024 Abril | 61 | 19 | 80 |
| 2024 Marzo | 68 | 30 | 98 |
| 2024 Febrero | 64 | 29 | 93 |
| 2024 Enero | 46 | 25 | 71 |
| 2023 Diciembre | 51 | 16 | 67 |
| 2023 Noviembre | 55 | 22 | 77 |
| 2023 Octubre | 65 | 16 | 81 |
| 2023 Septiembre | 55 | 28 | 83 |
| 2023 Agosto | 28 | 11 | 39 |
| 2023 Julio | 48 | 32 | 80 |
| 2023 Junio | 48 | 23 | 71 |
| 2023 Mayo | 40 | 23 | 63 |
| 2023 Abril | 38 | 26 | 64 |
| 2023 Marzo | 27 | 20 | 47 |
| 2023 Febrero | 47 | 18 | 65 |
| 2023 Enero | 33 | 33 | 66 |
| 2022 Diciembre | 60 | 41 | 101 |
| 2022 Noviembre | 21 | 24 | 45 |
| 2022 Octubre | 30 | 18 | 48 |
| 2022 Septiembre | 21 | 33 | 54 |
| 2022 Agosto | 19 | 22 | 41 |
| 2022 Julio | 43 | 28 | 71 |
| 2022 Junio | 30 | 20 | 50 |
| 2022 Mayo | 32 | 24 | 56 |
| 2022 Abril | 32 | 31 | 63 |
| 2022 Marzo | 33 | 30 | 63 |
| 2022 Febrero | 31 | 29 | 60 |
| 2022 Enero | 32 | 29 | 61 |
| 2021 Diciembre | 22 | 36 | 58 |
| 2021 Noviembre | 28 | 35 | 63 |
| 2021 Octubre | 43 | 43 | 86 |
| 2021 Septiembre | 25 | 34 | 59 |
| 2021 Agosto | 16 | 19 | 35 |
| 2021 Julio | 25 | 28 | 53 |
| 2021 Junio | 33 | 31 | 64 |
| 2021 Mayo | 34 | 34 | 68 |
| 2021 Abril | 37 | 36 | 73 |
| 2021 Marzo | 58 | 24 | 82 |
| 2021 Febrero | 40 | 30 | 70 |
| 2021 Enero | 18 | 23 | 41 |
| 2020 Diciembre | 27 | 12 | 39 |
| 2020 Noviembre | 25 | 19 | 44 |
| 2020 Octubre | 14 | 19 | 33 |
| 2020 Septiembre | 33 | 10 | 43 |
| 2020 Agosto | 23 | 15 | 38 |
| 2020 Julio | 15 | 12 | 27 |
| 2020 Junio | 40 | 30 | 70 |
| 2020 Mayo | 33 | 27 | 60 |
| 2020 Abril | 19 | 17 | 36 |
| 2020 Marzo | 25 | 25 | 50 |
| 2020 Febrero | 4 | 7 | 11 |
| 2020 Enero | 4 | 4 | 8 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 2 | 3 | 5 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 3 | 7 |
| 2019 Junio | 4 | 6 | 10 |
| 2019 Mayo | 5 | 22 | 27 |
| 2019 Abril | 5 | 6 | 11 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 3 | 3 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 38 | 2 | 40 |
| 2018 Enero | 28 | 9 | 37 |
| 2017 Diciembre | 72 | 7 | 79 |
| 2017 Noviembre | 17 | 4 | 21 |
| 2017 Octubre | 21 | 6 | 27 |
| 2017 Septiembre | 22 | 12 | 34 |
| 2017 Agosto | 22 | 6 | 28 |
| 2017 Julio | 16 | 9 | 25 |
| 2017 Junio | 25 | 15 | 40 |
| 2017 Mayo | 24 | 14 | 38 |
| 2017 Abril | 18 | 21 | 39 |
| 2017 Marzo | 14 | 28 | 42 |
| 2017 Febrero | 13 | 5 | 18 |
| 2017 Enero | 14 | 6 | 20 |
| 2016 Diciembre | 21 | 15 | 36 |
| 2016 Noviembre | 25 | 10 | 35 |
| 2016 Octubre | 28 | 16 | 44 |
| 2016 Septiembre | 0 | 2 | 2 |
| 2016 Agosto | 1 | 1 | 2 |
| 2016 Mayo | 0 | 1 | 1 |
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