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2</a>&#41;&#46; It displayed posterior reinforcement and Power Doppler imaging showed peripheral vascular poles&#46; The above findings &#40;the heterogeneity and significant vascularity at several poles of the lesion&#41; suggested malignancy&#44; which allowed us to request a rush histology study&#46; Histologic examination showed infiltration of the dermis by a malignant epithelial proliferation of cells with a squamous pattern of growth&#44; marked nuclear pleomorphism&#44; prominent nucleoli&#44; and several mitotic figures&#59; the proliferation formed solid nests with evident intercellular bridges and apoptotic cells &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> A and B&#41;&#46; There was also extensive necrosis and no signs of connection with the epidermis&#46; The proliferation extended as far as the peripheral and deep borders of the biopsy specimen&#46; With a diagnosis of poorly differentiated squamous cell carcinoma&#44; we requested a chest radiograph&#44; which showed a nodule in the left lung and a focal interstitial infiltrate containing septal lines and images of nodules in the right lung&#46; Positron emission-tomography-computed tomography confirmed the presence of a disseminated stage <span class="elsevierStyleSmallCaps">IV</span> lung tumor with a large pulmonary mass in the right upper lobe and multiple lung and bone metastases&#46; The study also showed a hypermetabolic soft tissue mass corresponding to the skin lesion on the right buttock&#46; The patient opted to have the lesion completely excised&#46; She was enrolled in a palliative care clinical trial by the oncology department&#44; but died 7 months later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The skin is a rare site of metastasis from internal malignancies and is estimated to be involved in 0&#46;5&#37; to 9&#37; of all cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;4</span></a> All types of malignant tumors can produce cutaneous metastasis&#44; but the type most likely to do this varies considerably from one series to the next&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous metastases from lung tumors are rare &#40;0&#37;-4&#37; depending on the series&#41; and are associated with a very poor prognosis as the mean survival is just 3 to 5 months&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Few cases have been reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> The clinical presentation of cutaneous metastases is highly variable and includes macules&#44; papules&#44; nodules&#44; and ulcerated lesions&#46; Cutaneous metastases from the lung are typically located on the chest wall&#44; the neck&#44; the abdominal wall&#44; the scalp&#44; or the face&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Squamous cell carcinoma is the least common histologic subtype of cutaneous metastasis from the lung&#46; Metastasis to the skin is the presenting manifestation of lung cancer in less than 1&#37; of cases&#44; and a high index of clinical suspicion is therefore essential&#46; Many cases are detected late in the course of disease and have no bearing on prognosis&#46; However&#44; in some cases such as ours&#44; their detection permits the diagnosis and treatment of an unknown primary tumor&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">High-frequency ultrasound is a fast&#44; affordable&#44; noninvasive technique that can strongly predict malignancy in cases of cutaneous metastasis&#46; Very few articles have been published on ultrasound studies of cutaneous metastases from tumors other than melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;9&#44;10</span></a> Giovagnorio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> found that a polycyclic shape and hypervascularity with multiple peripheral poles were indicative of cutaneous metastasis&#46; The differential diagnosis should include inflamed epidermal cysts&#44; cutaneous lymphomas &#40;which can be accompanied by considerable inflammation&#41;&#44; and cystic areas in patients with hidradenitis suppurativa&#46; In this last case&#44; sinus tracts and drainage sinuses will be observed both clinically and by ultrasound&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We have presented the case of a young woman with a cutaneous metastasis on the buttock that was the presenting manifestation of a squamous cell lung cancer in which ultrasound examination of the lesion suggested malignancy&#44; allowing us to accelerate the diagnostic process&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Cutaneous Metastasis in a Patient With Lung Cancer
Metástasis cutánea de carcinoma de pulmón
C. Martínez-Morána,
Autor para correspondencia
cmmoran@salud.madrid.org

Corresponding author.
, B. Echeverría-Garcíaa, R. Khedaouib, J. Borbujoa
a Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
b Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, Spain
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2</a>&#41;&#46; It displayed posterior reinforcement and Power Doppler imaging showed peripheral vascular poles&#46; The above findings &#40;the heterogeneity and significant vascularity at several poles of the lesion&#41; suggested malignancy&#44; which allowed us to request a rush histology study&#46; Histologic examination showed infiltration of the dermis by a malignant epithelial proliferation of cells with a squamous pattern of growth&#44; marked nuclear pleomorphism&#44; prominent nucleoli&#44; and several mitotic figures&#59; the proliferation formed solid nests with evident intercellular bridges and apoptotic cells &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> A and B&#41;&#46; There was also extensive necrosis and no signs of connection with the epidermis&#46; The proliferation extended as far as the peripheral and deep borders of the biopsy specimen&#46; With a diagnosis of poorly differentiated squamous cell carcinoma&#44; we requested a chest radiograph&#44; which showed a nodule in the left lung and a focal interstitial infiltrate containing septal lines and images of nodules in the right lung&#46; Positron emission-tomography-computed tomography confirmed the presence of a disseminated stage <span class="elsevierStyleSmallCaps">IV</span> lung tumor with a large pulmonary mass in the right upper lobe and multiple lung and bone metastases&#46; The study also showed a hypermetabolic soft tissue mass corresponding to the skin lesion on the right buttock&#46; The patient opted to have the lesion completely excised&#46; She was enrolled in a palliative care clinical trial by the oncology department&#44; but died 7 months later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The skin is a rare site of metastasis from internal malignancies and is estimated to be involved in 0&#46;5&#37; to 9&#37; of all cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;4</span></a> All types of malignant tumors can produce cutaneous metastasis&#44; but the type most likely to do this varies considerably from one series to the next&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous metastases from lung tumors are rare &#40;0&#37;-4&#37; depending on the series&#41; and are associated with a very poor prognosis as the mean survival is just 3 to 5 months&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Few cases have been reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> The clinical presentation of cutaneous metastases is highly variable and includes macules&#44; papules&#44; nodules&#44; and ulcerated lesions&#46; Cutaneous metastases from the lung are typically located on the chest wall&#44; the neck&#44; the abdominal wall&#44; the scalp&#44; or the face&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Squamous cell carcinoma is the least common histologic subtype of cutaneous metastasis from the lung&#46; Metastasis to the skin is the presenting manifestation of lung cancer in less than 1&#37; of cases&#44; and a high index of clinical suspicion is therefore essential&#46; Many cases are detected late in the course of disease and have no bearing on prognosis&#46; However&#44; in some cases such as ours&#44; their detection permits the diagnosis and treatment of an unknown primary tumor&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">High-frequency ultrasound is a fast&#44; affordable&#44; noninvasive technique that can strongly predict malignancy in cases of cutaneous metastasis&#46; Very few articles have been published on ultrasound studies of cutaneous metastases from tumors other than melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;9&#44;10</span></a> Giovagnorio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> found that a polycyclic shape and hypervascularity with multiple peripheral poles were indicative of cutaneous metastasis&#46; The differential diagnosis should include inflamed epidermal cysts&#44; cutaneous lymphomas &#40;which can be accompanied by considerable inflammation&#41;&#44; and cystic areas in patients with hidradenitis suppurativa&#46; In this last case&#44; sinus tracts and drainage sinuses will be observed both clinically and by ultrasound&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We have presented the case of a young woman with a cutaneous metastasis on the buttock that was the presenting manifestation of a squamous cell lung cancer in which ultrasound examination of the lesion suggested malignancy&#44; allowing us to accelerate the diagnostic process&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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