title: Tumors Involving Skin, Soft Tissue and Skeletal Muscle: Benign, Primary Malignant or Metastatic?
abstract: BACKGROUND
  Metastatic cancer with invasion of skin, soft tissue and skeletal muscle is not common. Examples presenting as soft tissue masses could sometimes lead to misdiagnosis with delayed or inappropriate management. The purpose of current study was to investigate clinical characteristics in the involvement of metastatic cancer.
  
  
  METHODS
  A total of 1,097 patients complaining of skin or soft tissue masses and/or lesions were retrospectively reviewed from January 2012 to June 2013. Tumors involving skin, soft tissue and skeletal muscle of head and neck, chest wall, abdominal wall, pelvic region, back, upper and lower extremities were included in the study.
  
  
  RESULTS
  Fifty-seven (5.2%) patients were recognized as having malignancies on histopathological examination. The most common involvement of malignancy was basal cell carcinoma, followed by cutaneous squamous cell carcinoma, sarcoma and melanoma. The most common anatomical location in skin and soft tissue malignancies was head and neck (52.6% of the malignancies). Four (0.36%) of the malignant group were identified as metastatic cancer with the primary cancer source from lung, liver and tonsil and the most common site was upper extremities. One of them unexpectedly expired during the operation of metastatic tumor excision at the scalp.
  
  
  CONCLUSIONS
  Discrimination between benign and malignant soft tissue tumors is crucial. Performance of imaging study could assist in the differential diagnosis and the pre-operative risk evaluation of metastatic tumors involving skin, soft tissue and skeletal muscle.
authors.affiliation: Division of Plastic and Reconstructive Surgery in the Instituition, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan E-mail : hchiwen@hotmail.com.
authors.forename: Chi-Ying
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Huang-Wen
authors.initials: HW
authors.lastname: Tsai
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Chang
authors.forename: Tsuo-Wu
authors.initials: TW
authors.lastname: Lin
authors.forename: Ke-Chung
authors.initials: KC
authors.lastname: Chang
authors.forename: Yo-Shen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D034861:Abdominal Wall; D000368:Aged; D000369:Aged, 80 and over; D001415:Back; D004814:Epidermal Cyst / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000556:secondary; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D035002:Lower Extremity; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology* / Q000556:secondary; D018482:Muscle, Skeletal; D018204:Neoplasms, Connective and Soft Tissue / Q000473:pathology*; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000556:secondary; D010388:Pelvis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000556:secondary; D035441:Thoracic Wall; D014067:Tonsillar Neoplasms / Q000473:pathology*; D034941:Upper Extremity