Unknown: Erythematous nodules on the right cheek and chin
Thaer Douri, AZ Shawaf
Dermatology Online Journal 15 (3): 13

Ministry of Health, Syria-Hama. s-dori@scs-net.org


Cutaneous metastases from internal malignancies are uncommon. We report on a 55-year-old man who presented with cutaneous metastases from a squamous cell carcinoma of the lung. Chest x-ray and chest Computerized Axial Tomography (CT) revealed the lung tumor.

Answer: Cutaneous metastasis from squamous cell carcinoma of the lung

Figure 1 Figure 2

Figure 3

A 55-year-old man noted a 2-month history of enlarging asymptomatic nodules on his right cheek and chin over a 2-month period. He had a 40-year history of cigarette smoking.

Figure 4 Figure 5

Figure 6

A biopsy revealed a tumor consistent with squamous cell carcinoma of unknown origin (Figs. 4 & 5). Further investigations were performed to determine the location of the primary tumor. Chest X-ray showed a mass within the right lung (Fig. 6); CT scan confirmed its nature and extension. A diagnosis of squamous cell carcinoma of the lung was established. The patient underwent chemotherapy but he died after 3 months.


Cutaneous metastases from internal malignancies are uncommon. The clinical appearance of cutaneous metastases varies over a wide morphologic spectrum. They present typically as asymptomatic cutaneous or subcutaneous nodules [3]. Malignant melanoma has a high frequency of metastasis to the skin, whereas skin metastasis from lung and kidney malignancies are less common [1]. In a review of 4,020 patients with metastatic squamous-cell carcinoma (SCC), cutaneous lesions occurred in 10.4 percent [2]. In a large Veterans Administration series, lung metastases were identified as the source of 28.6 percent of their cases of cutaneous metastases [3]. In another analysis of 50 patients having cutaneous metastasis, the most common primary tumor in men was in the lung (14%), but the most common primary tumor in women was carcinoma of the breast (20%) [4]. In five cases of cutaneous metastases from bronchogenic carcinoma, only 1 of the 5 patients was a woman [5]. In 3 cases the histopathology showed adenocarcinoma and in the remaining 2 cases the histopathology showed squamous cell carcinoma [5]. Metastasis to the skin from the upper aerodigestive tract is even more rare than from the lung. In a recent description of 2,491 patients with SCC of the upper aerodigestive tract, only 19 (0.763%) developed skin metastases [6].

In the large Veterans Administration study, the time between diagnosis of internal malignancy and cutaneous presentation averaged 33 months (range: 1 month to 22 years) [3]. In our patient, the metastases represented the first indication of tumor; this is true in only 7.8 percent of cases [3].

The prognosis of malignancies that produce cutaneous metastasis is poor and the average survival following diagnosis of cutaneous metastases is 7.5 months (range: 1 month to 8 years) [3]. Our patient died within 3 months.


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3. Cutaneous metastasis: a clinical, pathological, and immunohistochemical appraisal. Saeed S, Keehn CA, Morgan MB.J Cutan Pathol. 2004 Jul;31(6):419-30. [PubMed]

4. Metastases to the skin.Tharakaram S.Int J Dermatol. 1988 May;27(4):240-2. [PubMed]

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