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Cassalia F, Bolzon A, Ponzano M, Ventura L, Danese A, Del Fiore P, Belloni Fortina A, Jovine E, Perri G, Cillo U, Marchegiani G. The Importance of Reading the Skin: Cutaneous Metastases of Pancreatic Cancer, a Systematic Review. J Clin Med 2023; 13:104. [PMID: 38202111 PMCID: PMC10779471 DOI: 10.3390/jcm13010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pancreatic cancer is notorious for its aggressive nature and low survival rate, with less than 10% of patients surviving beyond five years. Early detection is difficult, but skin metastases can be a rare but significant indicator. This systematic review focuses on the epidemiology, clinical features, and histology of skin metastases from pancreatic cancer to determine their importance in early diagnosis and overall management of the disease. MATERIALS AND METHODS Following PRISMA guidelines, we conducted an exhaustive search of MEDLINE/PubMed, EMBASE, and SCOPUS databases up to June 2023, using specific keywords. Four independent investigators screened the studies using predefined criteria, and two investigators checked the accuracy and consistency of the data extraction. We assessed the quality of the trials using adapted criteria from the Joanna Briggs Institute. A narrative synthesis rather than a meta-analysis was chosen because of the different study designs. RESULTS The final analysis included 57 patients with skin metastases from pancreatic cancer. Cutaneous metastases, although rare, presented with approximately equal gender distribution and a mean age of 63.4 years. Predominantly non-umbilical (77%), these metastases showed clinical diversity, ranging from asymptomatic nodules to painful or ulcerated lesions. Notably, skin metastases often preceded the diagnosis of primary pancreatic cancer (58%). Primary tumor characteristics revealed different localizations, with adenocarcinoma being the most prevalent histological type (77%). A significant association (p = 0.008) was observed between pancreatic tumor location and the timing of presentation of skin metastases. Tumors located in the body and tail of the pancreas were more likely to manifest skin metastases as an initial clinical manifestation (62.2%) than those in the head of the pancreas (20.8%). CONCLUSIONS In conclusion, although skin metastases are rare, they are important indicators of pancreatic cancer, highlighting the need for multidisciplinary healthcare collaboration and thorough skin examination. Recognizing them could lead to earlier diagnosis, which is crucial in a cancer with limited treatment options.
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Affiliation(s)
- Fortunato Cassalia
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
| | - Anna Bolzon
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
| | - Monica Ponzano
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
| | - Laura Ventura
- Department of Statistics, University of Padua, 35121 Padova, Italy;
| | - Andrea Danese
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Medicine [DIMED], University of Padua, 35121 Padua, Italy; (F.C.); (A.B.); (M.P.); (A.B.F.)
- Department of Woman’s and Children’s Health, University of Padua, 35121 Padua, Italy
| | - Elio Jovine
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, 40133 Bologna, Italy;
| | - Giampaolo Perri
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, 40133 Bologna, Italy;
- Hepatopancreatobiliary and Liver Surgery, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35121 Padua, Italy; (G.P.); (U.C.)
| | - Umberto Cillo
- Hepatopancreatobiliary and Liver Surgery, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35121 Padua, Italy; (G.P.); (U.C.)
| | - Giovanni Marchegiani
- Hepatopancreatobiliary and Liver Surgery, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35121 Padua, Italy; (G.P.); (U.C.)
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Zhang Z, Guo S, Zuo C, Cheng C. A Case of Pancreatic Cancer With Rare Cutaneous and Muscle Metastases on 18F-FDG PET/CT Imaging. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00588. [PMID: 37276535 DOI: 10.1097/rlu.0000000000004699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT A 46-year-old man underwent PET/CT for metastatic survey 6 years after radical resection of pancreatic cancer. In addition to the increased uptake observed in the operative area, increased FDG uptake was also observed in the left external abdominal oblique muscle and the left frontal scalp. Both intramuscular and subcutaneous lesions were surgically excised and diagnosed as metastases from pancreatic cancer.
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Affiliation(s)
- Zeyu Zhang
- From the Departments of Nuclear Medicine
| | - Shiwei Guo
- Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | | | - Chao Cheng
- From the Departments of Nuclear Medicine
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3
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Gu L, Mehta PP, Rao D, Rotemberg V, Capanu M, Chou J, Lin S, Sigel CS, Busam KJ, Boyce L, Gordon A, O'Reilly EM. Pancreatic cancer: Cutaneous metastases, clinical descriptors and outcomes. Cancer Med 2023; 12:179-188. [PMID: 35666021 PMCID: PMC9844595 DOI: 10.1002/cam4.4916] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/11/2022] [Accepted: 05/17/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cutaneous metastases in pancreatic cancer (PC) are rare. Herein, we evaluate the clinical, genomic, and other descriptors of patients with PC and cutaneous metastases. METHODS Institutional databases were queried, and clinical history, demographics, PC cutaneous metastasis details, and overall survival (OS) from cutaneous metastasis diagnosis were abstracted. OS was estimated using Kaplan-Meier methods. RESULTS Forty patients were identified, and median age (Q1-Q3, IQR) of PC diagnosis was 66.0 (59.3-72.3, 12.9) years. Most patients had Stage IV disease at diagnosis (n = 26, 65%). The most common location of the primary tumor was the tail of the pancreas (n = 17, 43%). The most common cutaneous metastasis site was the abdomen (n = 31, 78%), with umbilical lesions occurring in 74% (n = 23) of abdominal lesions. The median OS (95% CI) was 11.4 months (7.0, 20.4). Twenty-three patients had umbilical metastases (58%), and 17 patients had non-umbilical metastases (43%). The median OS (95% CI) was 13.7 (7.0, 28.7) months in patients with umbilical metastases and 8.9 (4.1, Not reached) months in patients with non-umbilical metastases (p = 0.1). Sixteen of 40 (40%) patients underwent somatic testing, and findings were consistent with known profiles. Germline testing in 12 (30%) patients identified pathogenic variants in patients: CHEK2, BRCA1, and ATM. CONCLUSION Cutaneous metastases from PC most frequently arise from a pancreas tail primary site and most frequently occur in the umbilicus. Cutaneous metastases may generally be categorized as umbilical or non-umbilical metastases.
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Affiliation(s)
- Lilly Gu
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell MedicineNew YorkNew YorkUSA
| | - Paras P. Mehta
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Devika Rao
- Gastrointestinal Oncology Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Veronica Rotemberg
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Marinela Capanu
- Department of Epidemiology & BiostatisticsMemorial Sloan KetteringNew YorkNew YorkUSA
| | - Joanne Chou
- Department of Epidemiology & BiostatisticsMemorial Sloan KetteringNew YorkNew YorkUSA
| | - Sabrina Lin
- Department of Epidemiology & BiostatisticsMemorial Sloan KetteringNew YorkNew YorkUSA
| | - Carlie S. Sigel
- Department of PathologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Klaus J. Busam
- Department of PathologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Lindsay Boyce
- Memorial Sloan Kettering LibraryMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Allison Gordon
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Eileen M. O'Reilly
- Weill Cornell MedicineNew YorkNew YorkUSA
- Gastrointestinal Oncology Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- David M. Rubenstein Center for Pancreatic Cancer, MSKNew YorkNew YorkUSA
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Shi Y, Li SS, Liu DY, Yu Y. Cutaneous metastases of pancreatic carcinoma to the labia majora: A case report and review of literature. World J Gastrointest Oncol 2020; 12:1372-1380. [PMID: 33250968 PMCID: PMC7667456 DOI: 10.4251/wjgo.v12.i11.1372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cutaneous metastases originating from pancreatic cancer are relatively rare. The most common reported site of metastasis is the umbilicus, and this manifestation is known as the Sister Mary Joseph’s nodule. Non-umbilical cutaneous metastases are far less common, with only a few cases reported in the literature. Our case is the first case report, to our knowledge, on metastasis involving the labia majora and flat papules.
CASE SUMMARY A 49-year-old Chinese female patient presented with a number of red, swollen papules on the vulva for 2 mo. Histological examination of the labia majora lesion revealed metastatic adenocarcinoma. The serum levels of tumor biomarkers CA199, CA242, and CA125 were significantly elevated. B-mode ultrasound-guided needle biopsy of the pancreas demonstrated moderately and poorly differentiated adenocarcinoma. The patient finally declined treatment for financial reasons and died 3 mo later.
CONCLUSION Metastatic cutaneous lesions could indicate pancreatic cancer. Serum levels of tumor biomarkers may aid in diagnosing metastatic pancreatic adenocarcinoma.
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Affiliation(s)
- Ying Shi
- Department of Dermatology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shan-Shan Li
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Dan-Yan Liu
- Department of Radiology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yan Yu
- Department of Dermatology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Moon JI, Park JY, Jeon TJ, Choi JM, Shin WC, Sung JM, Kim YM, Kim HJ. Non-umbilical Cutaneous Metastasis of Pancreatic Adenocarcinoma as the First Clinical Manifestation: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 68:221-224. [PMID: 27780948 DOI: 10.4166/kjg.2016.68.4.221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Non-umbilical cutaneous metastases from pancreatic adenocarcinomas are extremely rare. Only a few cases have been reported in the literature. An 83-year-old Korean woman, with no previous medical history, presented with a painful nodule on her scalp. Histologic examination of the nodule revealed a metastatic adenocarcinoma, and immunohistochemical staining was positive for cytokeratin (CK) 7 and CK 19. These findings were consistent with a metastatic carcinoma of pancreatic origin. An abdominal computed tomography scan identified a mass on the pancreatic head and multiple enlarged lymph nodes. Pathological examination of an endoscopic ultrasound-guided fine needle biopsy of the pancreatic mass determined that it was a poorly differentiated carcinoma. The patient refused any treatment owing to her old age and short life expectancy. Four months later, the disease progressed rapidly, and the patient died.
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Affiliation(s)
- Ji In Moon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Min Choi
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Won Chang Shin
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - June Min Sung
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Moon Kim
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Kotsantis I, Economopoulou P, Dritsakos K, Oikonomopoulos N, Bakogeorgos M, Rapti C, Kentepozidis N. Extensive cutaneous metastases of pancreatic adenocarcinoma: a case report and review of the literature. Clin Case Rep 2017; 5:51-56. [PMID: 28096990 PMCID: PMC5224779 DOI: 10.1002/ccr3.737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/23/2016] [Accepted: 10/10/2016] [Indexed: 12/30/2022] Open
Abstract
Herein, we present the case of a patient with pancreatic cancer and nonumbilical cutaneous metastasis. Patients with pancreatic adenocarcinomas can develop extensive cutaneous metastases involving not only abdominal skin but also other unusual sites such as the scrotum.
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Affiliation(s)
- Ioannis Kotsantis
- 2 Department of Internal MedicineSection of Medical OncologyAttikon University HospitalSchool of MedicineNational Kapodistrian University of AthensAthensGreece
| | - Panagiota Economopoulou
- 2 Department of Internal MedicineSection of Medical OncologyAttikon University HospitalSchool of MedicineNational Kapodistrian University of AthensAthensGreece
| | | | | | | | - Cleopatra Rapti
- Department of Medical Oncology251 Airforce General HospitalAthensGreece
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7
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Kaoutzanis C, Chang MC, Abdul Khalek FJ, Kreske E. Non-umbilical cutaneous metastasis of a pancreatic adenocarcinoma. BMJ Case Rep 2013; 2013:bcr-2012-007931. [PMID: 23307465 DOI: 10.1136/bcr-2012-007931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pancreatic adenocarcinoma is one of the deadliest human malignancies with the majority of cases diagnosed late in the course of the disease. Cutaneous metastases originating from pancreatic cancer are rare. The most common site reported is the umbilicus. Non-umbilical cutaneous metastases are far less common with only a few cases reported in the literature. Our case involved a 43-year-old man with pancreatic carcinoma who was offered resection and a Whipple procedure was planned. Intraoperatively, the patient was found to have a widely metastatic disease not seen on preoperative imaging. Postoperatively, cutaneous metastasis in the scalp was discovered. Although rare, the recognition of non-umbilical cutaneous metastases of pancreatic adenocarcinoma can be of value because they can not only detect an underlying tumour but also guide management.
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8
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Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol 2012; 34:347-93. [PMID: 22617133 DOI: 10.1097/dad.0b013e31823069cf] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.
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9
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Horino K, Takamori H, Ikuta Y, Nakahara O, Chikamoto A, Ishiko T, Beppu T, Baba H. Cutaneous metastases secondary to pancreatic cancer. World J Gastrointest Oncol 2012; 4:176-80. [PMID: 22844548 PMCID: PMC3406282 DOI: 10.4251/wjgo.v4.i7.176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 07/10/2012] [Accepted: 07/12/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate prognoses after cutaneous metastases, derived from pancreatic cancer.
METHODS: We treated two patients with cutaneous metastases from pancreatic cancer. We reviewed 40 reported patients in addition to our cases and analyzed clinical features of cutaneous metastases from pancreatic cancer.
RESULTS: The median survival time (MST) was 5 mo after diagnoses of cutaneous metastases. The cumulative 2-year survival rate was 3.5%. The most frequent site of cutaneous metastases was the umbilicus. The MST of patients who were treated with chemotherapy or chemoradiotherapy (CRT) was 6.5 mo, which was statistically longer in comparison to patients without treatment. Prognoses of cutaneous metastases are similar to other metastatic sites from pancreatic cancer. Receiving chemotherapy or CRT was the only prognostic factor of cutaneous metastases from pancreatic cancer.
CONCLUSION: The prognoses of cutaneous metastases are similar to other metastatic pancreatic cancers. Receiving chemotherapy or CRT was the only prognostic factor of cutaneous metastases from pancreatic cancer.
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Affiliation(s)
- Kei Horino
- Kei Horino, Hiroshi Takamori, Yoshiaki Ikuta, Osamu Nakahara, Akira Chikamoto, Takatoshi Ishiko, Toru Beppu, Hideo Baba, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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10
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Val-Bernal JF, Mayorga M, Torio B, Mira C. Skin metastases as the presenting sign of pancreatic ductal adenocarcinoma in a renal transplant patient. Ann Saudi Med 2000; 20:253-6. [PMID: 17322671 DOI: 10.5144/0256-4947.2000.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J F Val-Bernal
- Department of Anatomical Pathology, Marques de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
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11
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Miyahara M, Hamanaka Y, Kawabata A, Sato Y, Tanaka A, Yamamoto A, Ueno T, Nishihara K, Suzuki T. Cutaneous metastases from pancreatic cancer. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1996; 20:127-30. [PMID: 8968868 DOI: 10.1007/bf02825511] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cutaneous metastases originating from pancreatic cancer are relatively rare. Five cases of metastatic pancreatic cancer to the skin are presented and discussed with a review of 17 previous case reports. In 20 cases, the cutaneous metastases were present prior to the diagnosis of pancreatic cancer. The most common site of cutaneous metastases originating from pancreatic cancer was the umbilicus. Although such cases are rare, it is important to note that metastatic lesions in the skin may be the first sign and one type of distant metastases originating from pancreatic cancer.
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Affiliation(s)
- M Miyahara
- Second Department of Surgery, Yamaguchi University, Japan
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12
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Abstract
The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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