Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 71, Num. 3, 2005, pp. 208-209

Indian Journal of Dermatology, Venereology and Leprology, Vol. 71, No. 3, May-June, 2005, pp. 208-209

Letter To Editor

Gastric carcinoma presenting as cutaneous metastases

Prabhash Kumar, Talwar Vineet, Vaid A.K., Doval D.C.

Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector - 4, Rohini, New Delhi

Correspondence Address: B7/99, Sector - 4, Rohini, New Delhi, kp_prabhash@rediffmail.com

Code Number: dv05069

Sir,

The skin is uncommonly involved by metastatic tumors. Breast carcinoma and pulmonary carcinoma are the most common carcinomas metastasizing to the skin. Skin metastases from stomach carcinoma are uncommon. Stomach carcinoma presenting as skin metastases alone is very rare and here we report such a case.

A 50-year-old man presented with multiple nodules on the chest, back and abdomen [Figure - 1]. Fine needle aspiration cytology from the nodule was suggestive of metastatic adenocarcinoma. His upper gastrointestinal endoscopy showed an ulcero-proliferative growth at the greater curvature of the stomach, a biopsy from which showed features of adenocarcinoma of the stomach. CT scan of abdomen and chest showed thickening at the greater curvature in the stomach, while the liver and chest were normal. Colonoscopy was normal.

On the basis of these findings he was diagnosed as a case of adenocarcinoma of stomach with skin metastases. He was started on palliative chemotherapy (5-fluorouracil 750 mg/m² on days 1-3 and cisplatin 75 mg/m² on day 1 every three weeks). On reassessment after three cycles of chemotherapy, he was found to have progressive disease. His general condition also deteriorated. He died three months after his diagnosis.

Carcinoma stomach presenting as metastases to the skin is rare.[1] It can present as a nodule, a cellulitis like skin lesion or as an erysipelas-like picture.[2],[3] The skin metastases may be isolated or may be associated with metastases at multiple sites. As these patients have carcinoma in an advanced stage, the usual goal of therapy is palliation. Some patients may respond very well to chemotherapy.[4] Our patient had progressive disease and did not respond to chemotherapy. The survival in patients with skin metastases from a primary lesion is usually poor. The median duration of survival after skin metastases from carcinoma stomach is not known due to paucity of data. In one study the median survival was only 1.2 months.[5] This case is being reported for its rarity and to highlight the poor outcome in such patients.

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