Case Report

Cutaneous Metastases of Signet Cell Carcinoma of the Rectum Without Accompanying Visceral Involvement

Authors: Saadettin Kilickap, MD, Sercan Aksoy, MD, Murat Dinçer, MD, Emine Arzu Saglam, MD, Şuayib Yalçn, MD

Abstract

Cutaneous metastasis of rectal carcinoma is a rare event. It occurs in fewer than 4% of all patients with rectal cancer. Although skin metastasis of rectal cancer is usually detected around surgical scars or on the abdominal wall, especially in the periumbilical region, it rarely presents at other sites. The early diagnosis of skin metastases in these patients is very important because it can alter treatment. A case of signet cell carcinoma of the rectum with cutaneous metastases without accompanying visceral involvement is presented, occurring 14 months after completion of adjuvant therapy.


Key points:


* Cutaneous metastases from carcinoma are relatively uncommon in clinical practice, but it is very important that they are recognized since the appearance of cutaneous metastases signals widespread metastatic disease, resulting in a poor prognosis.


* The skin metastasis of colorectal cancer without visceral involvement is very rare and relates to short survival. Cutaneous metastases from colorectal carcinomas usually occur in the surgical region.


* Cutaneous metastasis of rectal cancer usually occurs within two years of resection of the primary tumor. The average survival of a patient with cutaneous metastasis varies from 3 to 18 months.


* Any new skin nodule should be suspected as metastatic in a patient with a history of malignant disease, and patient education and careful examination by the physician can lead to early detection which may help alter the treatment and hence, the prognosis.

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References

1. 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.
 
2. Spencer PS, Helm TN. Skin metastases in cancer patients. Cutis 1987;39:119–121.
 
3. Gottlier JA, Schermer DR. Cutaneous metastases from carcinoma of the colon. JAMA1970;213:2083.
 
4. Lookingbill DP, Helm KF. Metastatic tumors. In: Demis J, ed. Clinical Dermatology. Philadelphia, Pa, Lippincott-Raven, 1997, pp 1–7.
 
5. Healey PM, Malott K, Chalet MD. Cancers metastatic to the skin. In: Friedman RJ, Rigel DS, Harris MN, Baker D, eds. Cancer of the Skin. Philadelphia, Pa, WB Saunders Co, 1991, pp 347–363.
 
6. De Friend DJ, Kramer E, Prescott R, et al. Cutaneous perianal recurrence of cancer after anterior resection using the EEA stapling device. Ann R Coll Surg Engl 1992;74:142–143.
 
7. Rendi MH, Dhar AD. Cutaneous metastases of rectal carcinoma. Dermatol Nurs 2003;15:131–132.
 
8. Stavrianos SD, McLean NR, Kelly CG, et al. Cutaneous metastases to the head and neck from colonic carcinoma. Eur J Surg Oncol 2000;26:518–519.
 
9. Koklu S, Barista I, Altundag MK, et al. An unusual case of metastatic rectal carcinoma presenting as thyroid nodule. Am J Gastoenterol 2000;95:3689.
 
10. Reingold IM. Cutaneous metastases from internal carcinoma. Cancer 1966;19:162–168.
 
11. Resnik KS. Spread, mechanism, and rotes of a cutaneous metastases or simply put: how did it get to the skin of the thigh? Am J Dermatopathol 1999;21:208–209.
 
12. Kauffman CL, Sina B. Metastatic inflammatory carcinoma of the rectum: tumor spread by three routes. Am J Dermatopathol 1997;19:528–532.
 
13. Herrera-Ornelas L, Petrelli N, Mittelman A. Subcutaneous metastases visceral metastases from an adenocarcinoma of the rectum. Dis Colon Rectum 1985;28:523–525.
 
14. Adani GL, Marcello D, Anania G, et al. Subcutaneous right leg metastases from rectal adenocarcinoma without visceral involvement. Chir Ital 2001;53:405–407.