Dermoscopy Shows Characteristics of Cutaneous Metastases of Visceral Cancers
In a case series reported in JAMA Dermatology, Chernoff et al found that dermoscopic identification of vascular structures in cutaneous nodules in patients with known cancer diagnosis should raise suspicion for cutaneous metastasis.
Study Details
In the study, high-quality dermoscopic images of biopsy-proven cutaneous metastases in 20 patients with known diagnosis of underlying visceral malignancy were examined. Patients had a mean age of 65 years (range, 30–84 years) and 13 were male. Primary cancers consisted of breast in six cases, colorectal in three, thyroid in two, ovarian in two, and endometrial, gastric, lung, bladder, peritoneal, melanoma, and leiomyosarcoma in one each. Lesions were suspected to be cutaneous metastases before biopsy in 15 cases. Lesions presented as a new nodule in the anatomic region of the primary cancer in 12 cases and as papules or plaques in 8.
Nonpigmented and Pigmented Lesions
Overall, 17 lesions were pink or flesh-colored and 3 were pigmented. A vascular pattern was observed in all nonpigmented lesions, with discrete vessels observed in 15 (88%). The most common vascular patterns were serpentine or linear irregular vessels (77%) and arborizing vessels (53%); 59% had more than one pattern and one lesion had only an arborizing pattern. Two lesions (12%) had structureless or homogeneous pink areas without discrete vessels.
In the three pigmented cases, all representing metastatic breast cancer, hyperpigmentation was observed clinically and was correlated with melanocytic patterns on dermoscopic evaluation. Brown streaks were observed in all lesions, blue-gray globules were found in two, and an overlying bluish hue was seen in one. Vascular and melanocytic patterns were observed in one lesion, characterized by pigmented streaks and dotted vessels. Melanocytes and melanophages were found within the nodules on histopathologic evaluation.
The investigators concluded: “Dermoscopically visible vascular structures within a cutaneous nodule in patients with a known cancer diagnosis should raise suspicion for cutaneous metastasis. Pigmentation in such lesions, in the absence of a history of melanoma, suggests a primary breast carcinoma. The high prevalence of vascular structures among cutaneous metastases may suggest a role for angiogenesis in their pathogenesis. These findings support the use of dermoscopy in the evaluation of suspected skin metastases or in the assessment of lesions of unknown origin in patients with cancer.”
Patricia L. Myskowski, MD, of Memorial Sloan-Kettering Cancer, is the corresponding author for the JAMA Dermatology article.
The study authors reported no potential conflicts of interest.
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