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Cutaneous Metastases

»	How often do internal malignancies metastasize to the skin?
»	By what three routes do internal malignancies metastasize to the skin?
»	How do malignant cells invade and metastasize?
»	What are the most common cancers that metastasize to the skin in women?
»	What are the most common cancers that metastasize to the skin in men?
»	Do metastases to the skin typically occur in random patterns?
»	Describe the most common presentations of malignancies metastatic to the skin.
»	What is alopecia neoplastica?
»	What is a Sister Mary Joseph’s nodule?
»	Which tumors usually present as a Sister Mary Joseph’s nodule?
»	Does basal cell carcinoma ever metastasize?
»	How do you diagnose a cutaneous metastasis?
»	What is the prognosis of a patient with a cutaneous metastasis?

Do metastases to the skin typically occur in random patterns?

A, Large metastatic nodule of prostate carcinoma. The lower abdomen and pubic area are common sites for metastases of genitourinary cancers. B, Lung carcinoma metastatic to the chest wall, which is the most common site. (Courtesy of Paul Thompson, MD.)

Fig. 48.2 A, Large metastatic nodule of prostate carcinoma. The lower abdomen and pubic area are common sites for metastases of genitourinary cancers. B, Lung carcinoma metastatic to the chest wall, which is the most common site. (Courtesy of Paul Thompson, MD.)

No. Different tumors demonstrate characteristic patterns of metastases (Table 48-1). A well-known example is ocular malignant melanoma, which frequently demonstrates metastasis to the liver. As a rule, cutaneous metastases usually appear in skin that is near the primary tumor (Fig. 48-2). Most regional metastases are probably spread through the lymphatic system, while distant metastases are more likely to occur via the hematogenous route.

Table 48-1. Characteristic Sites of Cutaneous Metastases
	PRIMARY TUMOR	SITE OF METASTASES
	Oral squamous cell carcinoma	Head and neck
	Thyroid carcinoma	Neck
	Lung	Chest wall
	Breast	Anterior chest wall
	Renal cell carcinoma	Head
	Gastrointestinal carcinoma	Abdomen
	Genitourinary carcinoma	Lower abdomen