Clinicopathologic correlation of cutaneous metastases: experience from a cancer center.
OBJECTIVE
To analyze the clinical, histopathologic, and immunohistochemical characteristics of skin metastases.


METHODS
Retrospective analysis (January 1, 1990, to December 31, 2005).


METHODS
Comprehensive cancer center.


METHODS
Fifty-one patients (21 men and 30 women) with biopsy-proven skin metastases and correlative clinical data.


METHODS
Four dermatopathologists reviewed a random mixture of metastases and primary skin tumors. Immunohistochemical studies for 12 markers were performed on the metastases, with skin adnexal tumors as controls.


METHODS
Clinical characteristics of cutaneous lesions, clinical outcomes, histologic features, and immunohistochemical markers.


RESULTS
Eighty-six percent (43 of 50) of the patients had known stage IV cancer, and skin metastasis was the presenting sign in 12% (6 of 50). In 45% (21 of 47) of the biopsies, the lesions were not suspected of being metastases owing to unusual clinical presentations. Seventy-six percent of the patients died of disease (median survival, 5 months). On pathologic review, many metastases from adenocarcinomas were either recognized or suspected, but the primary site was not easily identified based on histologic findings alone. Metastases from small cell carcinomas and sarcomas were histologically misinterpreted as primary skin tumors. Immunohistochemical analysis using a panel including p63, B72.3, calretinin, and CK5/6 differentiated metastatic carcinoma from primary skin adnexal tumors.


CONCLUSIONS
Cutaneous metastases can have variable clinical appearances and can mimic benign skin lesions. They are usually seen in patients with advanced disease, but they can be the presenting lesion. Although many metastatic adenocarcinomas can be recognized based on histologic findings alone, immunohistochemical analysis is an important diagnostic adjunct in some cases.
Sariya
Dinesh
D
Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Ruth
Karen
K
Adams-McDonnell
Rose
R
Cusack
Carrie
C
Xu
XiaoWei
X
Elenitsas
Rosalie
R
Seykora
John
J
Pasha
Terri
T
Zhang
Paul
P
Baldassano
Marisa
M
Lessin
Stuart R
SR
Wu
Hong
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002173:Cancer Care Facilities; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000556:secondary*
D014408:Biomarkers, Tumor