Doumit Gaby, Abouhassan William, Piliang Melissa P, Uchin Jeffrey M, Papay Francis
Department of Plastic Surgery, Institute of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Ann Plast Surg. 2013 Jul;71(1):60-2. doi: 10.1097/SAP.0b013e318248b5e9.
Cutaneous metastasis of esophageal cancer, in particular esophageal adenocarcinoma, is rare and metastasis to the scalp is extremely rare. We describe such a case that was originally diagnosed as an adnexal carcinoma. A 77-year-old male with a history of esophageal adenocarcinoma status after esophagectomy at our institution 4.5 years prior, presented to our plastic surgery clinic with a 2-month history of 2 temporoparietal scalp lesions. He was referred to our clinic by a community dermatologist who had performed a shave biopsy of the lesions. The clinical diagnosis was adnexal cyst. The history of esophageal carcinoma was not provided to the pathologist. The dermatopathology report came back as malignant adnexal neoplasm and considerations included apocrine carcinoma. We reexamined the pathologist's slides from the outside facility, comparing them to the histopathology from his esophagectomy. Histopathologic changes were identical. Thus, our surgical and postoperative approach changed significantly. Clinical suspicion should be high for cutaneous metastases in patients with a history of solid organ cancers. It is important for clinicians to illicit a history of malignancy. A biopsy should be performed on any suspicious lesions, and clinical data along with histopathology of the prior cancer resection(s) should be provided to the pathologist for comparison. Diagnosis of the suspicious lesion should be made before definitive excision, as this may change the approach, with the potential for postoperative chemotherapy and radiation. The definitive operative approach consists of surgical debulking with the evidence of negative margins. On the scalp, we feel that 5-mm margins are appropriate to obtain clear margins. One should appreciate the subdermal extent of metastases and adjust the margins accordingly. We recommend excising the galea with the skin as an en bloc resection. This will both assure clear deep margins of resection and assist in a tension-free closure of the scalp.
食管癌，尤其是食管腺癌的皮肤转移非常罕见，而转移至头皮极为罕见。我们报告了这样一例最初被诊断为附属器癌的病例。一名77岁男性，4.5年前在我院接受了食管腺癌切除手术，此次因颞顶部头皮出现2个病变2个月，就诊于我院整形外科门诊。他由一位社区皮肤科医生转诊而来，该医生对病变进行了削切活检。临床诊断为附属器囊肿。未向病理科医生提供食管癌病史。皮肤病理学报告显示为恶性附属器肿瘤，考虑为大汗腺癌。我们重新检查了外部机构病理科医生的切片，并将其与他食管切除术后的组织病理学切片进行比较。组织病理学改变是相同的。因此，我们的手术及术后治疗方案发生了显著变化。对于有实体器官癌病史的患者，应高度怀疑皮肤转移。临床医生了解恶性肿瘤病史很重要。应对任何可疑病变进行活检，并将临床资料以及先前癌症切除的组织病理学结果提供给病理科医生进行比较。在进行确定性切除之前，应先对可疑病变做出诊断，因为这可能会改变治疗方案，术后可能需要化疗和放疗。确定性手术方法包括手术减瘤，确保切缘阴性。对于头皮病变，我们认为5毫米的切缘足以获得清晰切缘。应了解转移灶在皮下的范围并相应调整切缘。我们建议将帽状腱膜与皮肤整块切除。这既能确保切除的深部切缘清晰，又有助于头皮无张力缝合。
