Wounds Resulting from Cutaneous Metastasis: A Retrospective Case Series and Literature Review

Introduction: Cutaneous metastasis from internal malignancies is rare, and its presentation as wounds is even less common. This study presents four cases of patients initially presenting with wounds, later diagnosed as cutaneous metastases from various carcinomas. The aim is to raise awareness among clinicians regarding this potential diagnosis and review the literature on the presentation, treatment, and outcomes of cutaneous metastases.Methods:A comprehensive literature review was conducted using PubMed, focusing on keywords such as cutaneous metastasis, wounds, patterns of skin metastasis, and specific carcinoma types (breast, bladder, colon, and penile). The cases presented herein are from a wound clinic at the Wound Care Program, Jobst Vascular Institute, ProMedica Health Network, Toledo, Ohio, involving patients diagnosed with cutaneous metastases from different carcinomas.Results:1. Breast Cancer: A 61-year-old female presented with violaceous macules and erosion on her left breast, later diagnosed as invasive ductal breast carcinoma.2. Colon Cancer: A 46-year-old female presented with a pink nodular lesion on her forehead and a red open wound on her left breast, both confirmed as cutaneous metastasis from colon adenocarcinoma.3. Bladder Cancer: An 87-year-old female had a single pink nodular lesion on her left lateral thigh, diagnosed as metastatic bladder carcinoma.4. Penile Squamous Cell Carcinoma: A 65-year-old male presented with multiple pink macules and papules extending from his left groin to the left thigh, confirmed as metastatic penile squamous cell carcinoma.Discussion: Cutaneous metastasis, though rare, should be considered in patients presenting with nonhealing wounds or unusual skin lesions, especially those with a history of carcinoma. Early biopsy and diagnosis are crucial for prompt treatment and potentially improving patient outcomes. Providers in wound clinics should remain vigilant for the possibility of cutaneous metastasis presenting as wounds, as illustrated by the cases presented in this study. Prompt action by providers who suspect cutaneous malignancy is essential for earlier detection and treatment, ultimately increasing a patient’s chances of survival. Further research and awareness are needed to better understand and manage cutaneous metastasis from various carcinomas.References:Johnson C, Friedmann DP, Gade A, et al. Cutaneous Manifestation as Initial Presentation of Metastatic Breast Cancer: A Systematic Review. Cutis. 2021;107(3):E29-E36. doi:10.12788/cutis.0223 Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol. 1990;22(1):19-26. doi:10.1016/0190-9622(90)70002-y Rebelakos A, Manthopoulos A, Hadjissotiriou GG. Unusual metastasis of bladder cancer. Br J Urol. 1989;64(2):198. doi:10.1111/j.1464-410x.1989.tb05991.x