Betlloch-Mas Isabel, Soriano-García Tamara, Boira Ignacio, Palazón Juan Carlos, Juan-Carpena Gloria, Sancho-Chust Jose N, Chiner Eusebi
Dermatology, Hospital General Universitario de Alicante, Alicante, ESP.
Pulmonology, Hospital Universitario San Juan Alicante, Alicante, ESP.
Cureus. 2021 Nov 28;13(11):e19970. doi: 10.7759/cureus.19970. eCollection 2021 Nov.
Cutaneous metastasis (CM), while uncommon, is usually an indicator of poor prognosis. With cancer patients living longer, the incidence of CM has increased, which justifies its analysis.
The objective of this study was to carry out a descriptive study of CM diagnosed for 18 years in a dermatology department of a tertiary care hospital and to assess the epidemiological, clinical, and histological variables that condition them, as well as data on their survival and prognosis.
We performed a descriptive study of cases of CM diagnosed over 18 years in the dermatology department of a tertiary referral hospital analyzing the following variables: patient age and sex, site of primary neoplasm, pathochronology, survival time, histological findings, immunohistochemical markers, the anatomical area affected, the clinical appearance of the metastasis, therapeutic plan, and existence of metastases in other regions. We checked normal distribution using the Kolmogorov-Smirnov test and then compared the quantitative variables using the Student's t-test (unpaired samples), Mann-Whitney test (non-normal distribution), analysis of variance (ANOVA; for more than two groups), and categorical variables using the chi-square or Fisher's exact test.
We included 37 cases (20 men and 17 women), of whom 32 had died. The mean age was 62 ± 15 years. CM detection was defined early in 8% of cases, synchronous in 32%, and metachronous in 60%. The most frequent primary tumor sites were lungs (24%), breasts (21%), and bladders (11%). Most metastases were solitary. The most frequent locations for CM were the scalp, trunk, armpits, and groin. Most lesions had a nodular presentation (81%). Squamous cell carcinoma and adenocarcinoma showed the same frequency in lung cancer CM. Breast cancer leading to CM was the most common invasive ductal carcinoma. The most aggressive cases, with the worst survival, originated in lung neoplasms. Therapeutic management for most patients involved surgery in combination with other procedures. The only difference detected between the lung and breast cancer CM was the predominance of lung tumors in men (89%) and breast tumors in women compared with metastases from other sites; breast cancer CM manifested more frequently as plaques and less frequently as nodules (p < 0.05) and was less frequently associated with multisystemic metastasis. In lung cancer CM, time from tumor diagnosis to CM occurrence was shorter (p < 0.01) and multisystemic metastasis was more frequent than in CM of other tumors.
CM tends to affect patients aged above 60 years and arises predominantly from lung cancer in men and breast cancer in women. The most typical locations are the chest and scalp, and the appearance is usually nodular. Survival after CM detection is low, particularly in lung cancer CM.
皮肤转移（CM）虽不常见，但通常是预后不良的指标。随着癌症患者寿命延长，CM的发病率有所增加，这使得对其进行分析具有合理性。
本研究的目的是对一家三级护理医院皮肤科18年来诊断的CM进行描述性研究，并评估影响其发生的流行病学、临床和组织学变量，以及生存和预后数据。
我们对一家三级转诊医院皮肤科18年来诊断的CM病例进行了描述性研究，分析了以下变量：患者年龄和性别、原发肿瘤部位、发病时间顺序、生存时间、组织学结果、免疫组化标志物、受累解剖区域、转移灶的临床表现、治疗方案以及其他区域是否存在转移。我们使用Kolmogorov-Smirnov检验检查正态分布，然后使用学生t检验（非配对样本）、曼-惠特尼检验（非正态分布）、方差分析（ANOVA；用于两组以上）比较定量变量，使用卡方检验或费舍尔精确检验比较分类变量。
我们纳入了37例患者（20例男性和17例女性），其中32例已死亡。平均年龄为62±15岁。8%的病例CM检测为早期，32%为同步，60%为异时。最常见的原发肿瘤部位是肺（占24%）、乳腺（占21%）和膀胱（占11%）。大多数转移灶为单发。CM最常见的部位是头皮、躯干、腋窝和腹股沟。大多数病变表现为结节状（占81%）。在肺癌CM中，鳞状细胞癌和腺癌出现频率相同。导致CM的乳腺癌最常见的是浸润性导管癌。生存最差的最具侵袭性的病例起源于肺部肿瘤。大多数患者的治疗管理包括手术联合其他治疗。肺癌CM和乳腺癌CM之间唯一检测到的差异是，与其他部位转移相比，男性肺癌转移占优势（89%），女性乳腺癌转移占优势；乳腺癌CM表现为斑块的频率更高，表现为结节的频率更低（p<0.05），与多系统转移相关的频率更低。在肺癌CM中，从肿瘤诊断到CM发生的时间更短（p<0.01），多系统转移比其他肿瘤的CM更常见。
CM往往影响60岁以上的患者，男性主要起源于肺癌，女性主要起源于乳腺癌。最典型的部位是胸部和头皮，外观通常为结节状。CM检测后的生存率较低，尤其是肺癌CM。
