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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?

How do you diagnose a cutaneous metastasis?

The diagnosis is best established by doing an excisional, incisional, or punch biopsy, and by submitting the specimen in formalin for routine processing. In addition to hematoxylin and eosin (H&E) stains, the pathologist can perform special histochemical stains (e.g., mucicarmine for mucin, Fontana- Masson for melanin) or immunoperoxidase studies (e.g., prostate-specific antigen for prostate cancer and calcitonin for medullary thyroid carcinoma). Problematic cases may require submission of part of the tumor for electron microscopy, or frozen for immunoperoxidase studies that cannot be done on formalin-fixed tissue. Less commonly, the tumor specimen is obtained by a fine-needle aspiration.