Albandak Maram, Albandak Miral, Abdallah Jasmin, Qawasmeh Mohammed
Internal Medicine, Al-Quds University, Jerusalem, PSE.
Pharmacy, Birzeit University Faculty of Pharmacy Nursing and Health Professions, Birzeit, PSE.
Cureus. 2023 Mar 24;15(3):e36621. doi: 10.7759/cureus.36621. eCollection 2023 Mar.
Cutaneous metastasis is a rare manifestation of internal malignancies. It usually occurs with the later progression of the disease and is associated with a poor prognosis. Common culprits of skin metastasis include lung cancer, melanoma, and colorectal cancer in men and breast cancer, colorectal cancer, and melanoma in women. Given these points, there is a low rate of cutaneous metastasis of colorectal cancer. When present, the most common sites include the abdominal wall and, less frequently, the face and the scalp. Rarely there is cutaneous metastasis to the upper extremity. Herein, we report the case of a female patient in her 50s who presented with a maculopapular rash of the right upper limb four years after her initial diagnosis of colonic adenocarcinoma. However, because of this rare manifestation, she was initially misdiagnosed with more common causes of a maculopapular rash. After a period of no improvement with preliminary treatment, a biopsy with immunohistochemical staining was undertaken, and the specimen stained positive for CK20 and CDX2, confirming metastatic colorectal malignancy. Skin lesions that are not responding to conventional therapy and those which have bizarre presentations can be a harbinger of internal malignancy and should be considered in the differential.
皮肤转移是内脏恶性肿瘤的一种罕见表现。它通常发生在疾病的晚期进展阶段，且与预后不良相关。皮肤转移的常见病因在男性中包括肺癌、黑色素瘤和结直肠癌，在女性中包括乳腺癌、结直肠癌和黑色素瘤。鉴于这些情况，结直肠癌的皮肤转移率较低。当出现皮肤转移时，最常见的部位包括腹壁，较少见的是面部和头皮。上肢发生皮肤转移的情况极为罕见。在此，我们报告一例50多岁的女性患者，她在初次诊断为结肠腺癌四年后，右上肢出现了斑丘疹样皮疹。然而，由于这种罕见的表现，她最初被误诊为斑丘疹样皮疹的更常见病因。经过初步治疗一段时间后病情无改善，遂进行了活检及免疫组化染色，标本CK20和CDX2染色呈阳性，确诊为转移性结肠恶性肿瘤。对传统治疗无反应且表现奇特的皮肤病变可能是内脏恶性肿瘤的先兆，在鉴别诊断时应予以考虑。
