Cutaneous metastases occur in up to 9 % of visceral malignancies,
but are rarely the first manifestation
4,5. Such an event is far
more common in men then in women for cancer of lung, kidney
and ovary
2,3.
Cutaneous metastases may rarely represent the first evidence
of malignancy 6. In one study, 6.3 % of patients with breast
cancer had skin involvement at time of diagnosis , but 3.5 % had this as the presenting sign 6. As in the previous reports
the first symptom was the cutaneous lesions in the scalp in
our patient.
The skin was only the eighteenth most common metastatic site in
Abrams’ report for breast carcinoma 7. The most common type
of metastatic carcinoma from the breast to the skin is inflammatory
carcinoma 7. Contrary to our case, skin metastases of the
breast show an undiff erentiated carcinoma pattern, and rarely an
adenocarcinoma pattern 7.
Histopathologic diagnosis is diff ucult to identify the site of primary
tumour. Immunohistochemical studies may be helpful. Cutaneous
metastases are usually stained with antibodies to keratin
proteins, as well as with anti-carcinoembryonic antigen, anti-epithelial
membrane antigen antibodies and ER/PR 8.
Cutaneous metastases preferentially occurs in the skin overlying
or proximal to the area of the primary tumour by direct extension
or through lymphatic vessels 8. Brownstein and Helwig reported
168 cases with cutaneous metastases, the lesions tended to appear
on the anterior chest wall and assosiated with generalized
metastatic disease 8,9. In our patient, cutaneous metastases
appeared in the scalp and in addition to the skin, there was liver,
lung and bone metastases, too.
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