Khaja Misbahuddin, Mundt Daniel, Dudekula Rizwan Ahmed, Ashraf Umair, Mehershahi Shehriyar, Niazi Masooma, Lvovsky Dimitry, Malik Sandeep, Diaz-Fuentes Gilda
Division of Pulmonary and Critical Care Medicine, Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA.
Department of Medicine, Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA.
Case Rep Oncol. 2019 Jun 26;12(2):480-487. doi: 10.1159/000501363. eCollection 2019 May-Aug.
Lung cancer has the highest mortality of all cancers in the United States. The incidence of lung cancer with metastases to the skin varies between 1-12%, with the highest incidence seen in men. Here, we present two cases of lung cancer presenting as skin metastasis. The first patient was an 80-year-old African American male who presented to the hospital for evaluation of a right upper back mass. A few months prior to admission, he was found to have a left lung mass on CT scan of the chest, he underwent biopsy which showed poorly differentiated SCC of the lung. He also had a skin biopsy which showed poorly differentiated carcinoma in the dermis consistent with metastatic SCC. He was started on chemotherapy, but could not tolerate it. He was accepted to hospice. The second patient was a 78-year-old Hispanic female who presented to the hospital with dyspnea, and a dry cough. Upon physical examination, a 2 × 2 cm ulcerated, wart-like nodule on the right palm was noted. Subsequent CT scan of the chest showed a partial collapse of the right middle lobe. A biopsy of the hand mass revealed well-to-moderately differentiated metastatic SCC favoring lung origin. A bronchoscopy biopsy showed invasive SCC. Subsequently her condition worsened and she passed away. Metastasis to the skin is an unusual presenting symptom of lung cancer. It is therefore essential to consider metastasis as a diagnosis in a patient with both a skin lesion and a smoking history.
肺癌在美国所有癌症中死亡率最高。肺癌转移至皮肤的发生率在1%至12%之间，男性发生率最高。在此，我们报告两例以皮肤转移表现的肺癌病例。首例患者是一名80岁的非裔美国男性，因右上背部肿块入院评估。入院前几个月，他在胸部CT扫描中发现左肺有肿块，接受活检显示为肺低分化鳞状细胞癌。他还进行了皮肤活检，显示真皮内低分化癌，符合转移性鳞状细胞癌。他开始接受化疗，但无法耐受。他被送入临终关怀病房。第二例患者是一名78岁的西班牙裔女性，因呼吸困难和干咳入院。体格检查时，发现右手掌有一个2×2厘米的溃疡、疣状结节。随后的胸部CT扫描显示右中叶部分肺不张。手部肿块活检显示为中分化至高分化转移性鳞状细胞癌，倾向于肺来源。支气管镜活检显示为浸润性鳞状细胞癌。随后她的病情恶化并去世。皮肤转移是肺癌不常见的表现症状。因此，对于既有皮肤病变又有吸烟史的患者，将转移作为诊断考虑至关重要。
