Primary skin manifestation of non-small-cell lung cancer – a case study

Pathological processes involving internal organs can manifest themselves through a variety of skin lesions. In the case of neoplasms, these include typical paraneoplastic syndromes, which themselves do not constitute neoplastic lesions [1, 2]. More rarely, in the case of 1–12% of neoplasms, metastatic lesions from primary foci located in internal organs appear on the skin [2–6]. The involvement of the skin in the course of neoplastic diseases means that the neoplasm has gained access to the systemic circulation, which confirms its late stage and significantly worsens the prognosis. The survival time of patients with metastases to the skin is usually less than 1 year [3, 7]. An interesting phenomenon is the occurrence of a metastasis in the skin already involved in a neoplastic process, usually benign, which is referred to as a “tumour-to-tumour metastasis” [4].
Cutaneous paraneoplastic syndromes can manifest under different forms, and usually include a variety of hyperkeratotic and sclerotic lesions. In the case of lung cancer, these are predominantly hyperkeratoses, including Bazex syndrome (cornification, nail eczema), ichthyosis acquisita, dermatomyositis and acanthosis nigricans [1]. Metastatic cutaneous lesions originating from lung cancer can take the form of hard, indolent, mobile, erythroid nodules covered with normal or inflamed skin. Typically, there is one or several nodules, but some cases include several hundred.
We report a case of primary skin presentation of lung cancer in a 66-year-old male patient, an ex-smoker, who was admitted to the hospital in medium-severe condition due to general weakness, exercise-induced dyspnoea and dry cough. On admission to the department, in the subcutaneous tissue and on the skin of the patient, palpable and macroscopically visible nodules were observed, 2–3 cm in diameter, tender on palpation, of a rosy-bluish colour (Figure 1). These lesions were located on the front of the chest near a post-sternotomy scar, and in the dorsal area of the neck, as well as in the left supraclavicular, left-groin and left-thigh areas. The exanthems were of a polymorphic nature, and varied in terms of their size, colour and tenderness. As indicated by the patient, they appeared a month before admission to the department. During the patient’s hospitalisation, new cutaneous lesions appeared and the old ones evolved. The lesion in the left groin area became spontaneously painful and showed signs of “fluctuation”....


View full text...