title: The "different face" of esophageal cancer: cutaneous manifestation of visceral malignancies.
abstract: Squamous cell carcinoma is the most common type of neoplasm of the esophagus with global incidence. Its early symptoms are often nonspecific as the disease could be detected only when metastases in various organs are already presented. Esophageal metastases present an extremely small part from all cutaneous metastases as the real incidence of cutaneous metastases due to cancer of the esophagus account for 0.5-9 % and only a small part of them are reported and rarely involve the facial region. Despite this, cutaneous metastases may be the first sign of malignancy of the esophagus, which immediately determined the worst prognosis and fatal outcome in these patients. Average survival prognosis at the time of diagnosis of esophageal carcinoma in stage IV is 4-6 months, while the survival-associated expectations in cases of associated skin lesions manifestation is 4 months. We present a rare case of esophagus carcinoma in advanced stage, presented with severe cutaneous metastasis in the face region, accompanied by heavy blood coughing and hematemesis, which led to fatal outcome in the reported patient. The incidence of cutaneous metastases due to this visceral malignancy is discussed, as we highlight the frequency of metastases as a first clinical sign in esophageal cancer. The mortality rate is high due to the advanced stage of progression of the disease or presented metastases spread at the time of diagnosis, while treatment-related mortality accounts 10.3 %.
authors.affiliation: Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, Armeiska str.11, Stara Zagora, Bulgaria. julian.r.ananiev@gmail.com.
authors.forename: Julian
authors.initials: J
authors.lastname: Ananiev
authors.affiliation: "Onkoderma"-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd, Sofia, Bulgaria. assia_chokoeva@abv.bg.
authors.forename: Anastasiya Atanasova
authors.initials: AA
authors.lastname: Chokoeva
authors.affiliation: Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, University Hospital "Prof. Dr. Stoyan Kirkovich", Armeiska str.11, Stara Zagora, Bulgaria. aizec@abv.bg.
authors.forename: Teodor
authors.initials: T
authors.lastname: Stamatov
authors.affiliation: Department "Medicines Use Control", Bulgarian Drug Agency, 8 Damian Gruev str., 1303, Sofia, Bulgaria. gkmaximov@gmail.com.
authors.forename: Georgi Konstantinov
authors.initials: GK
authors.lastname: Maximov
authors.affiliation: Medical College, Medical University of Varna, 84 Tzar Osvoboditel str, 9000, Varna, Bulgaria. varna2008@gmail.com.
authors.forename: Ilko
authors.initials: I
authors.lastname: Bakardzhiev
authors.affiliation: Department of Clinical Experimental Medicine, Unit of Dermatology, University of Messina (Italy) C/O A.O.U. "G. Martino", via Consolare Valeria,1 - 98125, Messina, Italy. cguarneri@unime.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Guarneri
authors.affiliation: Internal Medicine Unit, Guastalla Hospital, Ausl Reggio Emilia, Reggio Emilia, Italy. claudio.tana@yahoo.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tana
authors.affiliation: Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. wollina-uw@khdf.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Wollina
authors.affiliation: University of Rome "G. Marconi", Rome, Italy. professor@torellolotti.it.
authors.forename: Torello
authors.initials: T
authors.lastname: Lotti
authors.affiliation: Policlinic for Dermatology and Venereology, Medical Faculty, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak str. 1, 1407, Sofia, Bulgaria. georgi_tchernev@yahoo.de.
authors.forename: Georgi
authors.initials: G
authors.lastname: Tchernev
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D017809:Fatal Outcome; D006396:Hematemesis / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D009336:Necrosis; D009367:Neoplasm Staging; D011379:Prognosis; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D015996:Survival Rate
keywords: Bleeding; Cancer; Death; Esophagus; Metastasis