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Case Report/Case Series |

Dermoscopic Findings in Cutaneous Metastases

Karen A. Chernoff, MD1; Ashfaq A. Marghoob, MD2; Mario E. Lacouture, MD1,2; Liang Deng, MD, PhD1,2; Klaus J. Busam, MD3,4; Patricia L. Myskowski, MD1,2
[+] Author Affiliations
1Department of Dermatology, Weill Cornell Medical College, New York, New York
2Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
3Department of Pathology, Weill Cornell Medical College, New York, New York
4Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
JAMA Dermatol. 2014;150(4):429-433. doi:10.1001/jamadermatol.2013.8502.
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Importance  Cutaneous metastases rarely develop in patients with cancer but have important implications for prognosis and treatment. While dermoscopy is useful for many skin lesions, few data exist regarding dermoscopic findings in cutaneous metastases.

Observations  We reviewed high-quality dermoscopic images of 20 outpatients with biopsy-proven cutaneous metastases and known diagnosis of underlying visceral malignancy and correlated these findings with clinical and histologic data. Most lesions were pink or flesh-colored, but 3 of 20 were pigmented. All 17 nonpigmented lesions demonstrated a vascular pattern on dermoscopy, with 15 of 17 (88%) having discrete vessels and 2 of 17 (12%) showing pink homogeneous structureless areas. Serpentine, or linear irregular, vessels were most common. In the 3 pigmented lesions (all metastatic breast carcinoma), various melanocytic patterns were observed.

Conclusions and Relevance  Dermoscopically visible vascular structures within a cutaneous nodule in patients with a known cancer diagnosis should raise suspicion for cutaneous metastasis. Pigmentation in such lesions, in the absence of a history of melanoma, suggests a primary breast carcinoma. The high prevalence of vascular structures among cutaneous metastases may suggest a role for angiogenesis in their pathogenesis. These findings support the use of dermoscopy in the evaluation of suspected skin metastases or in the assessment of lesions of unknown origin in patients with cancer.

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Figure 1.
Cutaneous Metastatic Lesions in 3 Patients

A, Clinically, this vascular pink papule on the nose of a man in his 70s with bladder carcinoma was thought to represent a basal cell carcinoma before biopsy. B, Dermoscopy revealed multiple arborizing and serpentine vessels. C, Cutaneous metastasis manifesting as a dark pink umbilicated nodule on the face of a man in his 80s with ileocecal carcinoma. D, Dermoscopy revealed arborizing vessels originating in the center of the lesion. E, A woman in her 60s with ovarian cancer and several pink nodules on the thighs, buttocks, and groin. F, Dermoscopy revealed serpentine, comma-shaped, and arborizing vessels, as well as a blue-gray ovoid nest, mimicking basal cell carcinoma.

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Figure 2.
Cutaneous Metastatic Lesion in a Man in His 60s

A, The patient had metastatic melanoma manifesting as pink papules. B, Dermoscopy revealed dotted and serpentine vessels.

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Figure 3.
Cutaneous Metastatic Lesions in 2 Women With Breast Cancer

A, A woman in her 60s with a deeply pigmented brown nodule, centrally resembling a seborrheic keratosis. B, Dermoscopy revealed brown streaks with peripheral globules and a bluish hue, mimicking a blue-white veil overlying the central lesion. Focal milky red papillae are also seen. C, Histologic examination showed a dermal mass consistent with adenocarcinoma. D, On high-power magnification, melanophages and melanocytes are seen admixed with the tumor. E, A woman in her 40s with a firm brown nodule on the chest. F, Dermoscopy revealed central hypopigmentation with a periphery of pigmented streaks and small globules.

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