Ulcerative Cutaneous Lesions Synchronously Present with the Diagnosis of Primary Lung Cancer

1Cleveland Clinic, Cleveland, OH
2Tulane University Health Sciences Center, New Orleans, LA
3Peninsula Regional Medical Center, Salisbury, MD
4Cleveland Clinic, Cleveland, OH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 385

Case Presentation:

A 70‐year‐old male patient was admitted to the hospital with a 2‐month history of progressive worsening productive cough and exertional shortness of breath. His condition associated with malaise, loss of appetite and loss of weight of about 30 Ibs. He also noticed painless ulcerating skin lesions, progressively increasing in size over his face, neck and the scalp. He had a 60‐pack‐year history of smoking. On examination, vital signs were within normal limits. BMI was 17.1. He appeared lethargic with temporal and facial muscle wasting. Skin finding revealed multiple large, firm, mobile, nontender, ulcerative skin lesions with hyperemic centers and elevated rolled edges, were located on left side of the chin and scalp areas. Chest examination revealed diminished air entry with dullness to left upper chest. The chest x‐ray showed abnormal soft‐tissue fullness at the left hilum. CT chest showed a 5 cm large centrally located left upper lobe mass resulting in constriction to the left upper lobe bronchus and left upper lobe atelectasis, and associated with left hilar adenopathy. Bronchoscopy showed a mass at the junction of the left upper lobe and the lingula, completely occluding the entry to the left upper lobe and biopsies were obtained. Skin biopsy was performed and a result was consistent with poorly differentiated squamous cell carcinoma and was identical to the histopathology of the left lung mass. Overall, the patient's prognosis appeared very poor. The patient refused any further workup or interventions and died a few days after discharge.

Discussion:

Skin metastases from the lung are rare but must be ruled out in patients with suspicious skin lesions and history of smoking or lung cancer. The diagnosis is usually made using clinical information and skin biopsy should be obtained for histological examination. The percentage of patients with lung cancer that develop skin metastases ranges from 1% to 10%. The incidence of cutaneous metastasis is highest among patient with large‐cell carcinoma (2.5%) and low for squamous (0.7%) and small‐cell carcinoma (0.3%). In about 20%–60% of cases the skin lesions present before or at the same time with the diagnosis of the primary lung tumor. Skin lesions has been described in the literature as nodular or ulcerated, mobile or fixed, hard or flexible, single or multiple, and painless lesions. Treatment of solitary cutaneous metastases usually includes surgery alone or combined with chemotherapy, and/or radiation. In majority of the cases, skin metastases usually present as multiple lesions and with other internal metastases where chemotherapy is the primary option. Overall, skin metastases and their primaries in the lung are usually incurable and suggest a very poor prognosis.

Conclusions:

Skin metastases from the lung are rare. A particular high index of suspicion of skin metastases is required in individuals how present with suspicious skin lesions and history of smoking or lung cancer.

Skin finding revealed multiple large, firm, ulcerative skin lesions with hyperemic centers and elevated rolled edge over the left side of the chin (A) and the scalp (B). A nodular lesion also was seen on the right side of the neck (C). Computed tomography of the chest shows a 5‐cm large centrally located left upper lobe mass (arrow) resulting in constriction of the left upper lobe bronchus and left upper lobe atelectasis (arrowhead) associated with left hilar adenopathy.

To cite this abstract:

Shaheen K, Alrayies A, Baibars M, Alraies M. Ulcerative Cutaneous Lesions Synchronously Present with the Diagnosis of Primary Lung Cancer. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 385. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/ulcerative-cutaneous-lesions-synchronously-present-with-the-diagnosis-of-primary-lung-cancer/. Accessed September 16, 2019.

« Back to Hospital Medicine 2013, May 16-19, National Harbor, Md.