Journal of Dermatology 2016; 43: 95–98
doi: 10.1111/1346-8138.12983
CONCISE COMMUNICATION
Palliative surgical treatment for cutaneous metastatic tumor is a valid option for improvement of quality of life Hiroyuki GOTO,1,2 Toshikazu OMODAKA,1 Hiroto YANAGISAWA,1 Shusuke YOSHIKAWA,1 Yuichi YOSHIDA,2 Osamu YAMAMOTO,2 Yoshio KIYOHARA1 1
Department of Dermatology, Shizuoka Cancer Center, Shizuoka, 2Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Tottori, Japan
ABSTRACT A cutaneous metastatic tumor is relatively rare, and patients with such a tumor usually have a poor prognosis. Even if the metastases can be treated, the treatment cannot improve the prognosis. However, neglecting metastatic lesions sometimes results in a great deterioration of quality of life. Cutaneous metastatic foci are generally treated with chemotherapy and/or radiotherapy. On the other hand, surgical treatment is sometimes chosen for cutaneous metastases. In this study, we analyzed data for 40 patients with cutaneous metastatic tumors who received surgical treatment at Shizuoka Cancer Center between January 2009 and August 2014. Among these cases, lung cancer was the most common primary cancer and the craniocervical region was the most frequent metastatic site. Among the patients who died, the average duration to death after the operation was 186 days. We consider that resection of cutaneous metastatic tumors as palliative therapy is an appropriate therapeutic option if the patient’s condition permits resection. Such treatment can improve quality of life for both the patients and their families.
Key words:
cutaneous metastatic tumor, palliative therapy, prognosis, quality of life, surgery.
INTRODUCTION A cutaneous metastatic tumor is relatively rare: the incidence of cutaneous metastasis has been reported to be only 0.7–9% in patients with cancer.1–4 Generally, the prognosis for these patients is poor.5–7 Resection of the cutaneous metastasis is therefore not a radical therapy. However, cutaneous metastasis often becomes larger in size and some patients complain of pain, bleeding, exudate and offensive odor resulting in a great deterioration of quality of life (QOL). Therefore, we should consider the palliative resection of cutaneous metastasis for such disadvantages, even though it cannot improve the prognosis remarkably. In our department, we have sometimes performed surgical treatment of cutaneous metastasis as palliative therapy for patients who had been suffering from symptoms such as pain, bleeding and exudate, patients with a rapidly enlarging tumor and patients at risk for infection. However, data on surgical treatment for a large series of patients with cutaneous metastases have not been reported. Here, we present our experience of palliative surgical treatment and discuss the validity of such treatment.
METHODS Data for subjects were retrieved from a database of patients treated at Shizuoka Cancer Center between January 2009 and
August 2014. Data for 40 patients who underwent surgery for cutaneous metastatic lesions as palliative therapy were evaluated. Patients who had both lymph node metastases and direct skin infiltration and in-transit metastases were excluded because some of them underwent operations not palliatively but radically. Subjects were analyzed for age, sex, primary lesion, location of cutaneous metastasis, symptoms, sizes of excised lesion, other metastatic sites, performance statue, surgical and anesthesia procedure, local recurrence and duration to death after the operation. This study was approved by the ethics committee at Shizuoka Cancer Center.
RESULTS The data for the patients are shown in Table 1. The average age of the patients was 66 years (range, 27–91). Twenty-five patients (62.5%) were male and 15 (37.5%) were female. The primary lesions were mainly as follows: lung cancer in 12 patients (30%), skin cancer including malignant melanoma, squamous cell carcinoma and Merkel cell carcinoma in nine (22.5%), renal cancer in five (12.5%) and breast cancer in four (10%). Sites of the cutaneous metastasis were the craniocervical region in 17 patients (42.5%), thoracicoabdominal region in 10 (25%), back in nine (22.5%) and extremities in four (10%). Symptoms included pain in 19 patients (47.5%), bleeding or exudate in six (15%) and rapidly expanding cutaneous lesion in
Correspondence: Hiroyuki Goto, M.D., Department of Dermatology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan. Email: [email protected] Received 13 February 2015; accepted 7 May 2015.
© 2015 Japanese Dermatological Association
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H. Goto et al.
five (12.5%). There was no symptom in nine patients (22.5%). Fourteen of 19 patients complaining of pain had cutaneous metastatic tumors in the craniocervical region or on the back. Table 1. Patients with cutaneous metastatic tumors treated by surgery between 2009 and 2014 Patients (n = 40) Characteristic Age (years) Average Range Sex Male Female Primary lesion Lung cancer Skin cancer Renal cancer Breast cancer Colon cancer Pharyngeal cancer Esophageal cancer Thyroid cancer Unknown primary cancer Location of cutaneous metastasis Craniocervical region Thoracicoabdominal region Back Extremities Symptom Pain Bleeding or exudate Rapid expansion No local symptom Size of excised lesion (mm) Average Range Performance status 0 1 2 3 Other metastatic sites Bone Lung Lymph nodes Central nervous system Lever Other skin metastases No other site Surgical procedure Reefing Skin graft Local flap Anesthesia Local anesthesia General anesthesia Local recurrence Exist None
96
n
%
66 27–91 25 15
62.5 37.5
12 9 5 4 3 3 2 1 1
30 22.5 12.5 10 7.5 7.5 5 2.5 2.5
17 10 9 4
42.5 25 22.5 10
19 6 4 9
47.5 15 10 22.5
The tumors caused pain in the dorsal position (Fig. 1a). After surgical treatment, 17 of the 19 patients complaining of pain had improvement in the symptom. All of the six patients with bleeding or exudate showed improvement, and rapid expansion of the tumor was resolved in all of the five patients. Although we analyzed the favorite sites of cutaneous metastases and frequent symptoms for each primary cancer, there were no significant differences. The average size of the excised lesion was 21.7 mm (range, 5–41). An Eastern Cooperative Oncology Group (ECOG) performance status of the operation was 0 in 10 patients (25%), 1 in 21 (52.5%), 2 in seven (17.5%) and 3 in two (12.5%). Other metastatic sites on the operation were mainly the bone in 14 patients (35%), lung in 14 (35%), lymph nodes in 13 (32.5%) and central nervous system in 10 (25%). Two patients received skin graft and one patient received skin flap. Only three patients underwent surgery with general anesthesia. Two patients had local recurrence after operation. Among the patients who died (32 patients), the average duration to death after the operation was 186 days and the median duration was 110 days (range, 4–1235; Fig. 1b).
(a)
21.7 5–41 10 21 7 2
25 52.5 17.5 5
14 14 13 10 7 6 5
35 35 32.5 25 17.5 15 12.5
37 2 1
92.5 5 2.5
37 3
92.5 7.5
2 38
5 95
(b)
Figure 1. (a) Representative clinical picture of resected lesion. The metastasis on the back caused pain for the patient in the dorsal position. (b) Kaplan–Meier survival curve for 32 patients who died. The median survival duration after surgical treatment was 110 days and the average duration was 186 days.
© 2015 Japanese Dermatological Association
Surgery for cutaneous metastatic tumor
Table 2. Duration to death after the operation for each cancer Primary cancer Lung cancer Skin cancer Renal cancer Breast cancer Colon cancer Pharyngeal cancer Esophageal cancer Thyroid cancer Unknown primary cancer
Total (n)
Alive (n)
Average (days)
Range (days)
12 9 5 4 3 3 2 1 1
0 3 1 2 1 1 0 0 0
142.1 243.8 436.8 39 35.5 98.5 108.5 463 29
4–355 65–796 30–1235 25–53 23–48 86–111 107–110 463 29
DISCUSSION A cutaneous metastatic tumor is defined as the spread of tumor cells from the primary cancer to the skin.5 Vital prognosis is rarely influenced by a cutaneous metastatic tumor and is regulated by the clinical course of the primary lesion in most cases. For that reason, cutaneous metastasis is mainly treated with chemotherapy targeting the primary cancer, and only a few cases are treated by surgery. There is an abundance of data for cutaneous metastases from internal malignancies. Among them, lung cancer was the most frequent primary cancer followed by skin, renal and breast cancers. Brownstein et al. reported that skin metastases originated from lung cancer (24%), colorectal carcinoma (19%) and melanoma (13%) in men, and from breast cancer (69%), colorectal carcinoma (9%) and melanoma (5%) in women.6 Other studies showed almost the same results.8–10 In our study, the largest proportion of patients who received surgical treatment were those with metastases from lung cancer, while only a small proportion with metastases from breast cancer received surgical treatment. This is probably due to the type of cutaneous metastases. In the case of skin metastases from breast cancers, the foci show not only massive nodular lesions but also vast infiltrating plaque or erysipelas-like lesions. It is usually difficult to perform the surgical treatment for such large and deep lesions showing ill-defined and direct infiltration from the primary breast cancer. The sites of cutaneous metastases among the patients receiving surgical treatment tended to be the craniocervical region, thoracicoabdominal region and back. Metastases on the head and back often cause pain for patients in the dorsal position. In addition, cutaneous metastatic lesions are easily rubbed, causing hemorrhage in those locations. Therefore, we consider that cutaneous metastatic lesions on the head or back should be resected if the general condition of the patient is good. Actually, symptoms such as pain and hemorrhage were almost completely resolved after the operations in our cases. In the patients with inoperable skin metastases including erysipeloid carcinoma or multiple metastases, their symptoms continued, resulting in a great deterioration of QOL. The average size of metastatic lesion was approximately 20 mm. If the size of the lesion becomes larger, it is more
© 2015 Japanese Dermatological Association
difficult to perform the operation under local anesthesia. Only one-quarter of patients had ECOG performance status of 0 and most of the patients underwent operation under local anesthesia. As a result of our study, the size of approximately 40 mm may be an upper limit to resect metastatic cutaneous tumor as palliative therapy. Although local recurrence occurred in only three patients, some patients might die before recurrence. In the present study, the median survival duration after surgical treatment was 110 days and the average duration was 186 days. Schoenlaub et al. reported that the median survival period after development of cutaneous metastasis was 6.5 months, and Saeed et al. reported that the average survival period after diagnosis of cutaneous metastasis was 7.5 months.7,11 Although the duration in our cases seems to be shorter than that in past studies, our results were from data obtained not after the diagnosis but after the surgical treatment. In addition, there were some cases in which the surgical treatment resulted in a better outcome in our hospital. Some patients lived for more than 1 year, and some others, especially those with renal cancer, tended to have a better prognosis than the prognosis for patients with other cancers (Table 2). Cutaneous metastatic tumor is a troublesome disease that has little influence on prognosis for the patient but has great disadvantages for QOL. Some patients in a severe condition are not candidates for an operation and we must select other therapies for those cases including Mohs’ chemosurgery for controlling hemorrhage from metastatic cutaneous masses.12–14 If the patient’s general condition is stable, we should consider surgical treatment as an option for medical care. Surgical treatment can result in a dramatic improvement of QOL for the patients and their families as was shown in the present study.
CONFLICT OF INTEREST:
None
REFERENCES 1 Collier DA, Busam K, Salob S. Cutaneous metastasis of osteosarcoma. J Am Acad Dermatol 2003; 49: 757–760. rrez R, Paiva O. Cutaneous metastases. Clinical 2 Llancapi P, Gutie pathological review. Rev Med Chil 1996; 124: 1519–1523. 3 Tanriverdi O, Meydan N, Barutca S et al. Cutaneous metastasis of gallbladder adenocarcinoma in a patient with chronic lymphocytic leukemia: a case report and review of the literature. Ann Dermatol 2013; 25: 99–103. 4 Barbetakis N, Samanidis G, Paliouras D et al. Facial skin metastasis due to small-cell lung cancer: a case report. J Med Case Rep 2009; 3: 32. 5 Hussein MR. Skin metastasis: a pathologist’s perspective. J Cutan Pathol 2010; 37: e1–e20. 6 Brownstein MH, Helwig EB. Patterns of cutaneous metastasis. Arch Dermatol 1972; 105: 862–868. 7 Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: a clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol 2004; 31: 419–430. 8 Hu SC, Chen GS, Lu YW, Wu CS, Lan CC. Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal. J Eur Acad Dermatol Venereol 2008; 22: 735–740. 9 Sariya D, Ruth K, Adams-McDonnell R et al. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. Arch Dermatol 2007; 143: 613–620.
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H. Goto et al.
10 Chopra R, Chhabra S, Samra SG, Thami GP, Punia RP, Mohan H. Cutaneous metastases of internal malignancies: a clinicopathologic study. Indian J Dermatol Venereol Leprol 2010; 76: 125–131. 11 Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Survival after cutaneous metastasis: a study of 200 cases. Ann Dermatol Venereol 2001; 128: 1310–1315. 12 Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg 1941; 42: 279–295.
98
13 Tsukada T, Nakano T, Matoba M, Matsui D, Sasaki S. Locally advanced breast cancer made amenable to radical surgery after a combination of systemic therapy and Mohs paste: two case reports. J Med Case Rep 2012; 6: 360. 14 Uno H, Sasaki M, Osamura K, Ohtoshi S, Nakada T, Iijima M. Angiosarcoma (Stewart-Treves syndrome): palliative role of Mohs’ ointment. J Dermatol 2010; 37: 852–853.
© 2015 Japanese Dermatological Association
doi: 10.1111/1346-8138.12983
CONCISE COMMUNICATION
Palliative surgical treatment for cutaneous metastatic tumor is a valid option for improvement of quality of life Hiroyuki GOTO,1,2 Toshikazu OMODAKA,1 Hiroto YANAGISAWA,1 Shusuke YOSHIKAWA,1 Yuichi YOSHIDA,2 Osamu YAMAMOTO,2 Yoshio KIYOHARA1 1
Department of Dermatology, Shizuoka Cancer Center, Shizuoka, 2Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Tottori, Japan
ABSTRACT A cutaneous metastatic tumor is relatively rare, and patients with such a tumor usually have a poor prognosis. Even if the metastases can be treated, the treatment cannot improve the prognosis. However, neglecting metastatic lesions sometimes results in a great deterioration of quality of life. Cutaneous metastatic foci are generally treated with chemotherapy and/or radiotherapy. On the other hand, surgical treatment is sometimes chosen for cutaneous metastases. In this study, we analyzed data for 40 patients with cutaneous metastatic tumors who received surgical treatment at Shizuoka Cancer Center between January 2009 and August 2014. Among these cases, lung cancer was the most common primary cancer and the craniocervical region was the most frequent metastatic site. Among the patients who died, the average duration to death after the operation was 186 days. We consider that resection of cutaneous metastatic tumors as palliative therapy is an appropriate therapeutic option if the patient’s condition permits resection. Such treatment can improve quality of life for both the patients and their families.
Key words:
cutaneous metastatic tumor, palliative therapy, prognosis, quality of life, surgery.
INTRODUCTION A cutaneous metastatic tumor is relatively rare: the incidence of cutaneous metastasis has been reported to be only 0.7–9% in patients with cancer.1–4 Generally, the prognosis for these patients is poor.5–7 Resection of the cutaneous metastasis is therefore not a radical therapy. However, cutaneous metastasis often becomes larger in size and some patients complain of pain, bleeding, exudate and offensive odor resulting in a great deterioration of quality of life (QOL). Therefore, we should consider the palliative resection of cutaneous metastasis for such disadvantages, even though it cannot improve the prognosis remarkably. In our department, we have sometimes performed surgical treatment of cutaneous metastasis as palliative therapy for patients who had been suffering from symptoms such as pain, bleeding and exudate, patients with a rapidly enlarging tumor and patients at risk for infection. However, data on surgical treatment for a large series of patients with cutaneous metastases have not been reported. Here, we present our experience of palliative surgical treatment and discuss the validity of such treatment.
METHODS Data for subjects were retrieved from a database of patients treated at Shizuoka Cancer Center between January 2009 and
August 2014. Data for 40 patients who underwent surgery for cutaneous metastatic lesions as palliative therapy were evaluated. Patients who had both lymph node metastases and direct skin infiltration and in-transit metastases were excluded because some of them underwent operations not palliatively but radically. Subjects were analyzed for age, sex, primary lesion, location of cutaneous metastasis, symptoms, sizes of excised lesion, other metastatic sites, performance statue, surgical and anesthesia procedure, local recurrence and duration to death after the operation. This study was approved by the ethics committee at Shizuoka Cancer Center.
RESULTS The data for the patients are shown in Table 1. The average age of the patients was 66 years (range, 27–91). Twenty-five patients (62.5%) were male and 15 (37.5%) were female. The primary lesions were mainly as follows: lung cancer in 12 patients (30%), skin cancer including malignant melanoma, squamous cell carcinoma and Merkel cell carcinoma in nine (22.5%), renal cancer in five (12.5%) and breast cancer in four (10%). Sites of the cutaneous metastasis were the craniocervical region in 17 patients (42.5%), thoracicoabdominal region in 10 (25%), back in nine (22.5%) and extremities in four (10%). Symptoms included pain in 19 patients (47.5%), bleeding or exudate in six (15%) and rapidly expanding cutaneous lesion in
Correspondence: Hiroyuki Goto, M.D., Department of Dermatology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan. Email: [email protected] Received 13 February 2015; accepted 7 May 2015.
© 2015 Japanese Dermatological Association
95
H. Goto et al.
five (12.5%). There was no symptom in nine patients (22.5%). Fourteen of 19 patients complaining of pain had cutaneous metastatic tumors in the craniocervical region or on the back. Table 1. Patients with cutaneous metastatic tumors treated by surgery between 2009 and 2014 Patients (n = 40) Characteristic Age (years) Average Range Sex Male Female Primary lesion Lung cancer Skin cancer Renal cancer Breast cancer Colon cancer Pharyngeal cancer Esophageal cancer Thyroid cancer Unknown primary cancer Location of cutaneous metastasis Craniocervical region Thoracicoabdominal region Back Extremities Symptom Pain Bleeding or exudate Rapid expansion No local symptom Size of excised lesion (mm) Average Range Performance status 0 1 2 3 Other metastatic sites Bone Lung Lymph nodes Central nervous system Lever Other skin metastases No other site Surgical procedure Reefing Skin graft Local flap Anesthesia Local anesthesia General anesthesia Local recurrence Exist None
96
n
%
66 27–91 25 15
62.5 37.5
12 9 5 4 3 3 2 1 1
30 22.5 12.5 10 7.5 7.5 5 2.5 2.5
17 10 9 4
42.5 25 22.5 10
19 6 4 9
47.5 15 10 22.5
The tumors caused pain in the dorsal position (Fig. 1a). After surgical treatment, 17 of the 19 patients complaining of pain had improvement in the symptom. All of the six patients with bleeding or exudate showed improvement, and rapid expansion of the tumor was resolved in all of the five patients. Although we analyzed the favorite sites of cutaneous metastases and frequent symptoms for each primary cancer, there were no significant differences. The average size of the excised lesion was 21.7 mm (range, 5–41). An Eastern Cooperative Oncology Group (ECOG) performance status of the operation was 0 in 10 patients (25%), 1 in 21 (52.5%), 2 in seven (17.5%) and 3 in two (12.5%). Other metastatic sites on the operation were mainly the bone in 14 patients (35%), lung in 14 (35%), lymph nodes in 13 (32.5%) and central nervous system in 10 (25%). Two patients received skin graft and one patient received skin flap. Only three patients underwent surgery with general anesthesia. Two patients had local recurrence after operation. Among the patients who died (32 patients), the average duration to death after the operation was 186 days and the median duration was 110 days (range, 4–1235; Fig. 1b).
(a)
21.7 5–41 10 21 7 2
25 52.5 17.5 5
14 14 13 10 7 6 5
35 35 32.5 25 17.5 15 12.5
37 2 1
92.5 5 2.5
37 3
92.5 7.5
2 38
5 95
(b)
Figure 1. (a) Representative clinical picture of resected lesion. The metastasis on the back caused pain for the patient in the dorsal position. (b) Kaplan–Meier survival curve for 32 patients who died. The median survival duration after surgical treatment was 110 days and the average duration was 186 days.
© 2015 Japanese Dermatological Association
Surgery for cutaneous metastatic tumor
Table 2. Duration to death after the operation for each cancer Primary cancer Lung cancer Skin cancer Renal cancer Breast cancer Colon cancer Pharyngeal cancer Esophageal cancer Thyroid cancer Unknown primary cancer
Total (n)
Alive (n)
Average (days)
Range (days)
12 9 5 4 3 3 2 1 1
0 3 1 2 1 1 0 0 0
142.1 243.8 436.8 39 35.5 98.5 108.5 463 29
4–355 65–796 30–1235 25–53 23–48 86–111 107–110 463 29
DISCUSSION A cutaneous metastatic tumor is defined as the spread of tumor cells from the primary cancer to the skin.5 Vital prognosis is rarely influenced by a cutaneous metastatic tumor and is regulated by the clinical course of the primary lesion in most cases. For that reason, cutaneous metastasis is mainly treated with chemotherapy targeting the primary cancer, and only a few cases are treated by surgery. There is an abundance of data for cutaneous metastases from internal malignancies. Among them, lung cancer was the most frequent primary cancer followed by skin, renal and breast cancers. Brownstein et al. reported that skin metastases originated from lung cancer (24%), colorectal carcinoma (19%) and melanoma (13%) in men, and from breast cancer (69%), colorectal carcinoma (9%) and melanoma (5%) in women.6 Other studies showed almost the same results.8–10 In our study, the largest proportion of patients who received surgical treatment were those with metastases from lung cancer, while only a small proportion with metastases from breast cancer received surgical treatment. This is probably due to the type of cutaneous metastases. In the case of skin metastases from breast cancers, the foci show not only massive nodular lesions but also vast infiltrating plaque or erysipelas-like lesions. It is usually difficult to perform the surgical treatment for such large and deep lesions showing ill-defined and direct infiltration from the primary breast cancer. The sites of cutaneous metastases among the patients receiving surgical treatment tended to be the craniocervical region, thoracicoabdominal region and back. Metastases on the head and back often cause pain for patients in the dorsal position. In addition, cutaneous metastatic lesions are easily rubbed, causing hemorrhage in those locations. Therefore, we consider that cutaneous metastatic lesions on the head or back should be resected if the general condition of the patient is good. Actually, symptoms such as pain and hemorrhage were almost completely resolved after the operations in our cases. In the patients with inoperable skin metastases including erysipeloid carcinoma or multiple metastases, their symptoms continued, resulting in a great deterioration of QOL. The average size of metastatic lesion was approximately 20 mm. If the size of the lesion becomes larger, it is more
© 2015 Japanese Dermatological Association
difficult to perform the operation under local anesthesia. Only one-quarter of patients had ECOG performance status of 0 and most of the patients underwent operation under local anesthesia. As a result of our study, the size of approximately 40 mm may be an upper limit to resect metastatic cutaneous tumor as palliative therapy. Although local recurrence occurred in only three patients, some patients might die before recurrence. In the present study, the median survival duration after surgical treatment was 110 days and the average duration was 186 days. Schoenlaub et al. reported that the median survival period after development of cutaneous metastasis was 6.5 months, and Saeed et al. reported that the average survival period after diagnosis of cutaneous metastasis was 7.5 months.7,11 Although the duration in our cases seems to be shorter than that in past studies, our results were from data obtained not after the diagnosis but after the surgical treatment. In addition, there were some cases in which the surgical treatment resulted in a better outcome in our hospital. Some patients lived for more than 1 year, and some others, especially those with renal cancer, tended to have a better prognosis than the prognosis for patients with other cancers (Table 2). Cutaneous metastatic tumor is a troublesome disease that has little influence on prognosis for the patient but has great disadvantages for QOL. Some patients in a severe condition are not candidates for an operation and we must select other therapies for those cases including Mohs’ chemosurgery for controlling hemorrhage from metastatic cutaneous masses.12–14 If the patient’s general condition is stable, we should consider surgical treatment as an option for medical care. Surgical treatment can result in a dramatic improvement of QOL for the patients and their families as was shown in the present study.
CONFLICT OF INTEREST:
None
REFERENCES 1 Collier DA, Busam K, Salob S. Cutaneous metastasis of osteosarcoma. J Am Acad Dermatol 2003; 49: 757–760. rrez R, Paiva O. Cutaneous metastases. Clinical 2 Llancapi P, Gutie pathological review. Rev Med Chil 1996; 124: 1519–1523. 3 Tanriverdi O, Meydan N, Barutca S et al. Cutaneous metastasis of gallbladder adenocarcinoma in a patient with chronic lymphocytic leukemia: a case report and review of the literature. Ann Dermatol 2013; 25: 99–103. 4 Barbetakis N, Samanidis G, Paliouras D et al. Facial skin metastasis due to small-cell lung cancer: a case report. J Med Case Rep 2009; 3: 32. 5 Hussein MR. Skin metastasis: a pathologist’s perspective. J Cutan Pathol 2010; 37: e1–e20. 6 Brownstein MH, Helwig EB. Patterns of cutaneous metastasis. Arch Dermatol 1972; 105: 862–868. 7 Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: a clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol 2004; 31: 419–430. 8 Hu SC, Chen GS, Lu YW, Wu CS, Lan CC. Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal. J Eur Acad Dermatol Venereol 2008; 22: 735–740. 9 Sariya D, Ruth K, Adams-McDonnell R et al. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. Arch Dermatol 2007; 143: 613–620.
97
H. Goto et al.
10 Chopra R, Chhabra S, Samra SG, Thami GP, Punia RP, Mohan H. Cutaneous metastases of internal malignancies: a clinicopathologic study. Indian J Dermatol Venereol Leprol 2010; 76: 125–131. 11 Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Survival after cutaneous metastasis: a study of 200 cases. Ann Dermatol Venereol 2001; 128: 1310–1315. 12 Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg 1941; 42: 279–295.
98
13 Tsukada T, Nakano T, Matoba M, Matsui D, Sasaki S. Locally advanced breast cancer made amenable to radical surgery after a combination of systemic therapy and Mohs paste: two case reports. J Med Case Rep 2012; 6: 360. 14 Uno H, Sasaki M, Osamura K, Ohtoshi S, Nakada T, Iijima M. Angiosarcoma (Stewart-Treves syndrome): palliative role of Mohs’ ointment. J Dermatol 2010; 37: 852–853.
© 2015 Japanese Dermatological Association
