Clinical presentation
A 66-year-old man with a history of hepatocellular carcinoma (HCC) and hepatitis B presented with a 2 cm, asymptomatic chin nodule growing rapidly for 2 months (Fig 1).
Fig 1.
Two centimeter, red, shiny nodule on the left chin.
Dermatoscopic appearance
Dermoscopy showed a diffuse red homogeneous lesion with a white veil, chrysalis-like shiny white lines, white dots, red lacunae, and a skin-colored collarette (Fig 2). A positive rainbow sign was present.
Fig 2.
Dermoscopic image under polarized light and direct contact showing a red homogeneous lesion with a white veil, multiple chrysalis-like shiny white lines (black arrows), white dots (circled), a positive rainbow sign (red arrows), and a surrounding skin-colored collarette. Red lacunae are also visualized (white arrow).
Histologic diagnosis
Histopathology revealed an atrophic epidermis with effaced rete ridges, islands of eosinophilic cells with pleomorphic nuclei, and numerous vascular spaces with extravasated red blood cells (Fig 3).
Key message.
Cutaneous metastasis of HCC is rare, accounting for less than 0.8% of all cutaneous metastases, but its recognition is crucial for detecting internal malignancy.1 These metastases typically present as firm, painless, red or bluish papules or nodules of varying sizes on the face, scalp, chest, or shoulders, sometimes with ulceration. This case highlights novel dermoscopic findings, including crystalline structures and the rainbow sign, previously unreported in HCC metastases. These unique features, along with red lacunae, white dots, and disorganized vessels, can help differentiate cutaneous HCC metastasis from clinical mimickers such as amelanotic melanoma and vascular tumors (eg, lobular capillary hemangioma). Early recognition and accurate diagnosis are vital, as cutaneous HCC metastasis generally indicates a poor prognosis and necessitates prompt management of both primary and metastatic lesions.2
Fig 3.
Histopathological image revealing atrophic epidermis with effaced rete ridges, islands of eosinophilic cells with small pleomorphic nuclei, and numerous small vascular spaces.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Patient consent: The authors obtained written consent from patients for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors.
IRB approval status: Not applicable.
References
- 1.Chernoff K.A., Marghoob A.A., Lacouture M.E., et al. Dermoscopic findings in cutaneous metastases. JAMA Dermatol. 2014;150(4):429–433. doi: 10.1001/jamadermatol.2013.8502. [DOI] [PubMed] [Google Scholar]
- 2.Jia J., Luo J., Zou B., et al. Non-iatrogenic implantation of cutaneous metastasis from hepatocellular carcinoma. J Cancer Res Clin Oncol. 2023;149(4):1513–1519. doi: 10.1007/s00432-022-04030-0. [DOI] [PMC free article] [PubMed] [Google Scholar]