Cutaneous metastasis from squamous cell carcinoma of the cervix A n n e G. Hayes, M D , and Allen D. Berry III, M D Memphis, Tennessee Metastasis to the skin occurs rarely, regardless of the nature of the primary systemic neoplasm. Although carcinoma of the cervix is the fourth most common malignancy in women, cutaneous involvement originating from cervical cancer is particularly unusual, even in the terminal stages of disease. Only 22 cases, including this one, are clearly documented in the literature. The main sites of the cutaneous metastases in these cases were the abdominal wall or lower extremity. However, we describe a 41-year-old woman with cervical cancer who developed metastatic nodules on the upper back. The skin of the back is an uncommon location for metastasis from any malignant tumor, and when it occurs in women, it is generally associated with carcinoma of the breast or malignant melanoma. To the best of our knowledge, this is the first reported case of cervical carcinoma metastasis to this unlikely cutaneous site. (J AM ACAD DERMATOL 1992;26:846-50.)

Cutaneous metastasis f r o m an internal malignancy occurs infrequently, particularly in comparison with the incidence of met astasis to noncutaneous sites.t, 2 Combined d a t a f r o m five large-scale studies by Rosen 3 suggest that the incidence of cutaneous metastasis is approximately 2% (146 cases in 7196 autopsies). In addition, A b r a m s et al. 2 ranks the skin as the twenty-first most frequent metastatic site for all primary tumors. According to Brownstein and Helwig, 4 carcin o m a of the breast is the leading primary tumor to produce cutaneous metastasis among women, followed by carcinoma of the large intestine, malignant melanoma, and carcinoma of the ovary. These authors report only four cases (2%) of cutaneous metastasis f r o m carcinoma of the cervix. 5 Likewise, in a review by Brady et al. 6 of women with cervical cancer, only five patients (0.01%) developed cutaneous metastasis. We describe a 41-year-old w o m a n with cutaneous metastases from primary cervical carcinoma and review the 21 previously documented cases of cervical carcinoma with secondary involvement of the integument.l, 5-t4

Fromthe Departments&Pathologyand Medicine-Dermatology,Universityof Tennesseeat Memphis,and BaptistMemorialHospital. Reprint requests:Allen D. Berry IlI, MD, Departmentof Pathology, Baptist Memorial Hospital, 899 Madison Ave., Memphis, TN 38146. 16/4/34738

846

CASE REPORT A 37-year-old nulliparous white woman noted irregular bleeding and postcoital bleeding during the past year. Her mother had bilateral breast cancer and her father had both lung and prostate cancer. Pelvic examination revealed an endophytic tumor replacing the cervix with left parametrial extension. No other significant physical findings were noted. Results of proctoscopic and cystoscopic examinations were normal. Cervical biopsy and endocervical curettage specimens revealed invasive, moderately differentiated squamous cell carcinoma (Fig. 1). The tumor was staged as IIB, and the patient was treated with external and intracavitary radiation. The patient was unavailable for follow-up until 4 years later, when she was readmitted to the hospital because of a 6-week history of increasing shortness of breath, a 25pound weight loss, and bilateral pleuritic chest pain. Examination revealed two firm, freely-movable, 1 cm subcutaneous nodules on the right upper back (Fig. 2). A biopsy specimen revealed metastatic, moderately differentiated squamous cell carcinoma, which was histologically identical to the previous carcinoma of the cervix. The tumor extensively infiltrated the dermis with many nests of cells within dermal lymphatic spaces. The epidermis was intact (Fig. 3). A computerized axial tomographic scan of the abdomen and chest confirmed metastases to both the liver and lungs. The patient died 1 month later. DISCUSSION Fifty years ago cervical carcinoma was one of the leading causes of cancer deaths in women in the

Volume Number May

26 5, P a r t

2

Metastatic

1992

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Cutaneous metastasis from squamous cell carcinoma of the cervix.

Metastasis to the skin occurs rarely, regardless of the nature of the primary systemic neoplasm. Although carcinoma of the cervix is the fourth most c...
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