Elsevier

Urology

Volume 63, Issue 6, June 2004, Pages 1021-1026
Urology

Adult urology: CME
Cutaneous metastases from genitourinary malignancies

https://doi.org/10.1016/j.urology.2004.01.014Get rights and content

Abstract

Objectives

To review the world literature for reports of cutaneous metastases from primary genitourinary malignancies and compare them with our experience during a 10-year period. Cutaneous metastases from primary visceral malignancies are uncommon manifestations of advanced disease. Among patients with urologic malignancies, the incidence and appearance of cutaneous metastases are not well established and recognition is poor among practicing urologists.

Methods

A Medline search and manual bibliographic review was performed to identify peer-reviewed reports pertaining to cutaneous metastases from all visceral malignancies. A comparative review of all pertinent cases arising from primary urologic malignancies was performed. A comprehensive search of our institution's tumor registry was performed to identify all analytic cases of urologic malignancy diagnosed, treated, and followed up between 1990 and 2000. Clinical and pathologic data were collated.

Results

We identified 2,369 reported cases of cutaneous metastases arising from 81,618 primary solid visceral malignancies, for an overall incidence of 2.9%. Dermatologic spread from primary urologic malignancies of the kidney, bladder, prostate, or testes was noted in 116 (1.3%) of 10,417. The incidence of cutaneous metastases from the kidney, bladder, prostate, and testes was 3.4%, 0.84%, 0.36%, and 0.4%, respectively. Overall, 436 cases of cutaneous metastases from urologic organs were identified in the English-language literature. We identified nine additional cases of pathologically confirmed cutaneous metastatic urologic tumors at our institution in the past 10 years. The most common presentation was an infiltrated plaque or nodules. Most cases displayed clinical features that mimicked common skin disorders. The median disease-specific survival was less than 6 months from the presentation of cutaneous metastasis.

Conclusions

Cutaneous metastases from urologic tumors are uncommon and occur in 1% of patients with advanced disease. Urologic skin metastases are most common from renal tumors, followed by those of the bladder and then prostate. Their clinical appearance may mimic other common dermatologic disorders affecting patients with advanced malignancies. Definitive diagnosis requires an index of suspicion and skin biopsy. Cutaneous metastases from urologic malignancies are associated with a poor prognosis.

Section snippets

Material and methods

A Medline search and manual bibliographic review were performed to identify peer-reviewed articles in the English literature from 1966 to 2003 pertaining to cutaneous metastases from all visceral malignancies. Reports from the literature preceding 1966 were reviewed when cited by subsequent investigators. Cutaneous manifestations of hematologic malignancies were excluded. These data were then collated by primary organ site. Pathologically unsubstantiated cases, as well as all cases of needle

Results

We identified 2369 cases of cutaneous metastases arising from 81,618 primary solid malignancies reported in the literature, for an overall incidence of 2.9%1, 2, 3, 4, 5, 6, 7, 8 (Table I). Dermatologic spread from primary urologic malignancies of the bladder, prostate, or kidney was noted in 116 (1.1%) of 10,417 cases. Of these, 38 cases (0.84%) of cutaneous metastatic transitional cell carcinoma (TCC) from 4516 cases have been reported,2, 5, 6, 7, 8, 9, 10 8 cases (0.36%) of metastatic

Comment

Cutaneous metastases from solid primary tumors are uncommon. Evaluating the largest retrospective studies during the past 65 years, the incidence of metastasis to the skin from visceral malignancies ranged from 0.3% to 9.0% in more than 81,000 recorded cases (Table I).1, 2, 3, 4, 5, 6, 7, 8 The most common primary tumors metastasizing to the skin depend on the sex of the affected individual and include breast (69%) followed by colon (9%), lung (4%), and ovary (4%) in women and lung (24%)

Conclusions

Cutaneous metastases from urologic malignancies are uncommon manifestations of advanced disease. Among genitourinary tumors, metastasis to the skin from RCC is the most common followed by bladder and then prostate tumors. Most lesions occur on the trunk and are multiple and nodular. Their appearance may mimic other dermatologic disorders, and definitive identification requires an index of suspicion and skin biopsy. Recognition of this entity is important for practicing urologists.

References (31)

  • B. Held et al.

    Cutaneous metastases from malignant genitourinary disease

    South Med J

    (1972)
  • L.W. Brady et al.

    Unusual sites of metastases

    Semin Oncol

    (1977)
  • P.S. Spencer et al.

    Skin metastases in cancer patients

    Cutis

    (1987)
  • K. Fujita et al.

    Two cases of inflammatory skin metastasis from transitional cell carcinoma of the urinary bladder

    Urol Int

    (1994)
  • L.E. McCrea et al.

    Carcinoma of the prostate, metastases, therapy and survival

    J In Coll Surg

    (1958)
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