https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/35 Tue, 02 Aug 2016 09:15:52 +0000 A 51 year old man presented with multiple painless skin nodules throughout his body for 3 weeks. He complained of cramping pain in his calf muscles and thighs for 3 months, occasional fever with chills for 2 months and lost about 10kgs in these 3 months. Initially he was diagnosed as a case of viral myositis. His CPK and LDH were raised, febrile antigens and widal test were negative, CA 19-9 was very high (5018 u/ml). Biopsy of skin nodules showed features of metastatic adenocarcinoma. Address for Correspondence: Mazharul Huque Khan, Professor, Department of Surgery, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh, E-mail: mazhar.huque@gmail.com   Cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice, but is very important to be recognized. Skin involvement has been reported as the first sign in approximately 1% of patients suffering from internal malignancy. Involvement of skin can occur as a result of direct extension of tumor, local or distant metastasis. Early recognition helps in accurate and prompt diagnosis and timely treatment. A high index of suspicion is required because the clinical findings may be subtle. The recognition of cutaneous metastasis often dramatically alters therapeutic plans as it signals to widespread dissemination and poor prognosis. Case report   The excised nodule was about 2cmx3cm in size, oval in shape, firm to hard in consistency, with irregular surface. Cut surface was fleshy at look.     Fig-2. Cutaneous nodule on the anterior aspect of right MICROSCOPIC appearance of excised nodule:   Fig-3. Biopsy taken from one of the multiple nodules Diagnosis: The case was diagnosed as one of adenocarcinoma, metastatic in nature.                         Histo-pathological slides of cutaneous nodule:   Discussion Cutaneous metastases are commonly early indicators of metastatic disease.5 Diagnosis may be delayed for several months unless the skin lesion grows rapidly or other sites such as the lung or liver are affected by tumour spread.6 In general, skin metastasis is a poor prognostic sign. If the primary tumour is the lung, cervix or the oesophagus most patients die within three months. In the case of colorectal cancer however skin involvement is not a preterminal event.7 Treatment involves radiotherapy or excision and patients may survive up to a year.7,8   1.  Spencer PS, Helm TN. Skin metastases in cancer patients. Cutis 1987; 39:119-121. 3.  Johnson WC. Metastatic carcinoma of the skin: incidence and dissemination. In Lever’s Histopathology of the Skin, 8th edn, Edited by Elder D, Elenitsas R, Jaworsky C, Johnson Jr. B, Lippincott-Raven, Philadelphia, 1997; 1011-1018. 5.  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: 228–236. 7.  Brady LW, O’Neill EA, Farber SH. Unusual sites of metastases. Semin Oncol 1977; 4: 59–64. 2026 Ibrahim Medical College. All rights reserved.