Cutaneous Metastases of Colon Carcinoma

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Image Source: The New England Journal of Medicine

A 59-year-old man, known case of metastatic colon cancer, had a history of painless and non-itchy skin lesions for 10 weeks. The skin lesions were seen merging around a 3-year-old abdominal scar of hemicolectomy. The same incision was used for liver resection and cholecystectomy.

 The initial impression was shingles, for which the patient was referred to the dermatology clinic.

On inspection of the abdomen, obvious ascites was observed. The lesions were vesicular, firm, and pink to violaceous in color.

There was a strong clinical suspicion of cutaneous metastases of colon carcinoma.

A skin biopsy confirmed the diagnosis of metastatic colon adenocarcinoma.

Palliative care was provided to the patient. He succumbed to death 5 months after this presentation.

Cutaneous metastasis of internal malignancies is rare. Around 2.3-6%[i] of the cases show skin mets, which usually appear within two years after the resection of the primary tumor.

Skin sites nearer to the primary tumor are more likely to have the metastases/metastatic lesion; for example, the abdominal skin is the site for cutaneous metastases of colon carcinoma. The histopathology of such skin lesions resembles the primary malignancy.

Skin metastases reflect poor prognosis of colon carcinoma. Palliative treatment is the appropriate management approach once multiple cutaneous metastases appear. Solitary lesions may be surgically excised[ii]. Radiotherapy can be used as palliative therapy for local lesions.

Median survival after cutaneous metastasis of CRC is 18 months[iii] (range: between 1-34 months).


References:

[i] Nesseris, I., Tsamakis, C., Gregoriou, S., Ditsos, I., Christofidou, E., & Rigopoulos, D. (2013). Cutaneous metastasis of colon adenocarcinoma: case report and review of the literature. Anais brasileiros de dermatologia88(6 Suppl 1), 56–58. https://doi.org/10.1590/abd1806-4841.20132441

[ii] Wong NS, Chang BM, Toh HC, Koo WH. Inflammatory metastatic carcinoma of the colon: a case report and review of the literature. Tumori. 2004;90:253–255.

[iii] D. P. Lookingbill, N. Spangler, and K. F. Helm, “Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients,” Journal of the American Academy of Dermatology, vol. 29, no. 2, pp. 228–236, 1993.

Case Source: Grant Randall, M. a. (2020, June 11). Cutaneous Colon Cancer Metastases in a Surgical Scar. Retrieved from The New Egland Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1910443

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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