PDF(Pubmed)
Abstract：
Cutaneous metastases occur in approximately 10% of oncology patients as a feature of a persistent solid tumor or the harbinger of recurrent neoplastic disease. However, they can be the presenting manifestation of an unsuspected visceral malignancy in one percent of previously cancer-free individuals. Metastatic skin lesions from breast carcinoma are diverse in their appearance. The clinical presentation of cutaneous metastases in three women with breast cancer is described and both the morphology of skin metastases caused by breast carcinoma and the conditions that are mimicked by breast cancer cutaneous metastases are reviewed. Skin metastases from breast carcinoma commonly appear as firm, flesh-colored to red, smooth or ulcerated or crusted, nodules, papules, and plaques on the ipsilateral chest wall and breast. However, unique sites of breast cancer cutaneous metastases are the eyelids, inframammary folds, ipsilateral lymphedematous arm, scalp, subungual nail bed, and umbilicus; in addition, skin metastases can occur in mastectomy scars and radiation therapy ports. Carcinoma erysipelatoides, carcinoma telangiectoides, and carcinoma en cuirasse are classic patterns of skin metastases that can be observed in breast cancer patients; carcinoma hemorrhagiectoides is a recently observed skin metastases pattern that has also been noted in oncology patients with breast carcinoma. The pleomorphic skin lesions of breast cancer metastases can masquerade as benign cutaneous lesions and tumors (such as a collision tumor, cyst, dermatofibroma, and milia-en-plaque), cutaneous malignancies (such as melanoma and non-melanoma skin cancers), infections (such as cellulitis, folliculitis, herpes zoster, and paronychia), reactive erythema (such as erythema annulare centrifugum, and urticaria), skin conditions (such as alopecia areata, dermatitis, hidradenitis suppurativa, and scleroderma), and vascular lesions (such as angiokeratoma, angiosarcoma, lymphangioma circumscriptum, purpura, and pyogenic granuloma). In addition, breast carcinoma cutaneous metastases can not only mimic other miscellaneous conditions such as erosions and ulcers, Paget\'s disease, and papillomatosis cutis lymphostatica but also have unusual morphology such as targetoid lesions or a sharply demarcated red infiltration of the nasal tip similar to a clown\'s nose. The possibility of a breast cancer cutaneous metastasis should be considered in the evaluation of a patient with breast cancer--and although less likely, in a cancer-free individual--who develops a new and/or a treatment-unresponsive cutaneous lesion. A biopsy of the skin lesion is necessary to confirm the diagnosis of breast cancer cutaneous metastasis.
摘要：
大约10％的肿瘤患者发生皮肤转移，这是持续性实体瘤的特征或复发性肿瘤疾病的先兆。然而,在1%以前没有癌症的个体中，它们可能是未被怀疑的内脏恶性肿瘤的表现。乳腺癌的转移性皮肤病变的外观多种多样。描述了三名乳腺癌女性皮肤转移的临床表现，并回顾了乳腺癌引起的皮肤转移的形态和乳腺癌皮肤转移所模仿的状况。乳腺癌的皮肤转移通常表现为坚硬，肉色到红色，光滑或溃疡或结痂，结节,丘疹,以及同侧胸壁和乳房上的斑块。然而,乳腺癌皮肤转移的独特部位是眼睑，乳房下褶皱,同侧淋巴水肿臂，头皮,甲下甲床，和脐带；此外，皮肤转移可能发生在乳房切除术疤痕和放射治疗端口。癌，丹毒，毛细血管外翻癌，和癌是可以在乳腺癌患者中观察到的皮肤转移的经典模式；癌出血是最近观察到的皮肤转移模式，在乳腺癌的肿瘤学患者中也已注意到。乳腺癌转移的多形性皮肤病变可以伪装成良性皮肤病变和肿瘤（如碰撞肿瘤，囊肿,皮肤纤维瘤,和milia-en-plaster)，皮肤恶性肿瘤（如黑色素瘤和非黑色素瘤皮肤癌），感染（如蜂窝织炎，毛囊炎,带状疱疹,和甲沟炎)，反应性红斑(如环状红斑离心，和荨麻疹），皮肤状况(如斑秃，皮炎,化脓性汗腺炎,和硬皮病)，和血管病变（如血管角化瘤，血管肉瘤,包皮淋巴管瘤,紫癜,和化脓性肉芽肿）。此外,乳腺癌皮肤转移不仅可以模仿其他杂项条件，如糜烂和溃疡，佩吉特病,和乳头状瘤病，但也有不寻常的形态，如目标样病变或鼻尖的清晰分界红色浸润，类似于小丑的鼻子。在评估乳腺癌患者时，应考虑乳腺癌皮肤转移的可能性-尽管可能性较小，在无癌个体中-发展新的和/或治疗无效的皮肤病变。皮肤病变的活检对于确认乳腺癌皮肤转移的诊断是必要的。
