Introduction
A large proportion of esophageal cancers present initially in an advanced stage (1). Extra-nodal metastases are seen in 20% of the patients (2),(3), the liver and lungs are the more common places (2),(3). Cutaneous metastases (CM) are rarely reported (4)-(12).
We report two cases of skin metastases from esophageal cancer.
Case report
Case 1
A 68-year-old male patient presented with dysphagia for 3 months. Upper endoscopy and computerized tomography disclosed a mid-thoracic esophageal squamous cell carcinoma with extension to the airway rendering the tumor inoperable. No extra-nodal metastasis was noticed. The patient presented concomitantly with two red non-painful fast-growing nodules with ulceration in the nose and neck (Fig 1). Biopsy disclosed a squamous cell carcinoma considered a metastasis due to the atypical and rapid grow for a primary skin lesion since histology cannot differentiate both conditions. The patient was sent to oncologic clinical treatment.
Figure 1. Cutaneous metastases from an esophageal squamous cell carcinoma.
Case 2
A 73- year-old male patient presented with skin lesion 2 years after a total gastrectomy and distal esophagectomy for esophagogastric junction cancer followed by adjuvant chemotherapy (T3N1M0). Physical examination revealed an extensive area of the abdomen covered by red plaques (Fig 2). Biopsy disclosed an adenocarcinoma. No other site of recurrence was detected. Patient was referred to clinical oncologic treatment.
Figure 2. Cutaneous metastases from an esophagogastric junction adenocarcinoma.
Discussion
The skin is an uncommon site of metastases. CM was found in only 10% of a large series with over 4000 cases of metastatic cancer (4). Skin metastases from esophageal cancer affect less than 1% of the cases (9),(13). It may originate from squamous cell carcinoma as well as from adenocarcinoma (4)-(12). Skin metastases from esophagogastric junction tumors with similar characteristics to gastric cancer have also been described (7) as for that matter skin metastases from gastric tumors have also been rarely reported (9),(14),(15). A myriad of presentations may be seen, however, nodules are the most common form (5),(8),(10). Any location in the body may be affected (4).
The presence of CM denotes an advanced disease. Survival is dismal with an average of 4 months (4). Surgeons must be aware that cutaneous lesions may represent the first sign of systemic spreading of esophageal carcinoma (4),(9).
Footnotes
No potential conflict of interest.
References
- 1.Lightdale CJ. Esophageal cancer. American College of Gastroenterology. Am J Gastroenterol. 1999;94:20–9. doi: 10.1111/j.1572-0241.1999.00767.x. [DOI] [PubMed] [Google Scholar]
- 2.van Vliet EP, Steyerberg EW, Eijkemans MJ, Kuipers EJ, Siersema PD. Detection of distant metastases in patients with oesophageal or gastric cardia cancer: a diagnostic decision analysis. Br J Cancer. 2007;97:868–76. doi: 10.1038/sj.bjc.6603960. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.van Vliet EP, Eijkemans MJ, Kuipers EJ, Hermans JJ, Steyerberg EW, Tilanus HW, et al. A comparison between low-volume referring regional centers and a high-volume referral center in quality of preoperative metastases detection in esophageal carcinoma. Am J Gastroenterol. 2006;101:234–42. doi: 10.1111/j.1572-0241.2006.00413.x. [DOI] [PubMed] [Google Scholar]
- 4.Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol. 1993;29:228–36. doi: 10.1016/0190-9622(93)70173-q. [DOI] [PubMed] [Google Scholar]
- 5.Stein RH, Spencer JM. Painful cutaneous metastases from esophageal carcinoma. Cutis. 2002;70:230–2. [PubMed] [Google Scholar]
- 6.Roh EK, Nord R, Jukic DM. Scalp metastases from esophageal adenocarcinoma. Cutis. 2006;77:106–8. [PubMed] [Google Scholar]
- 7.Nisi G, Grimaldi L, Brandi C, Silvestri A, Brafa A, Calabrò M, et al. Cutaneous metastases of the superior lip from adenocarcinoma of the gastro-oesophageal junction. A case report. Chir Ital. 2007;59:883–6. [PubMed] [Google Scholar]
- 8.Fereidooni F, Kovacs K, Azizi MR, Nikoo M. Skin metastases from an occult esophageal adenocarcinoma. Can J Gastroenterol. 2005;19:673–6. doi: 10.1155/2005/536547. [DOI] [PubMed] [Google Scholar]
- 9.Hu SC, Chen GS, Wu CS, Chai CY, Chen WT, Lan CC. Rates of cutaneous metastases from different internal malignancies: experience from a Taiwanese medical center. J Am Acad Dermatol. 2009;60:379–87. doi: 10.1016/j.jaad.2008.10.007. [DOI] [PubMed] [Google Scholar]
- 10.Park JM, Kim DS, Oh SH, Kwon YS, Lee KH. A case of esophageal adenocarcinoma metastasized to the scalp. Ann Dermatol. 2009;21:164–7. doi: 10.5021/ad.2009.21.2.164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Riley S, Wah T. Cutaneous metastasis of esophageal adenocarcinoma with an unusual presentation. J Clin Ultrasound. 2007;35:289–92. doi: 10.1002/jcu.20295. [DOI] [PubMed] [Google Scholar]
- 12.Adyanthaya R. Multiple cutaneous metastases from esophageal adenocarcinoma. J Gastrointest Cancer. 2008;39:22–5. doi: 10.1007/s12029-009-9059-x. [DOI] [PubMed] [Google Scholar]
- 13.Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995;76:1120–5. doi: 10.1002/1097-0142(19951001)76:7<1120::aid-cncr2820760704>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
- 14.Aneiros-Fernandez J, Husein-ElAhmed H, Arias-Santiago S, Escobar Gómez-Villalva F, Nicolae A, O'Valle Ravassa F, et al. Cutaneous metastasis as first clinical manifestation of signet ring cell gastric carcinoma. Dermatol Online J. 2010;16:9. [PubMed] [Google Scholar]
- 15.Xavier MH, Vergueiro Tde R, Vilar EG, Pinto JM, Issa MC, Pereira GB, et al. Cutaneous metastasis of gastric adenocarcinoma: an exuberant and unusual clinical presentation. Dermatol Online J. 2008;14:8. [PubMed] [Google Scholar]