CASE REPORT Cutaneous Metastatic Disease in Cervical Cancer: A Case Report Anita Agrawal, MBBS, FRCSC, 1 Annie Yau, MD, MSc, MCFP, 2 Anthony Magliocco, MD, FRCPC, FACP, 3,4 Pamela Chu, MD, FRCSC 5 1 Department of Obstetrics and Gynecology and Reproductive Sciences, Royal University Hospital, Saskatoon SK 2 Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB 3 Tom Baker Cancer Centre, Calgary AB 4 Department of Oncology, University of Calgary, Calgary AB 5 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Calgary, Calgary AB Abstract Background: Cervical cancer metastasizes to skin in < 2% of patients. Cutaneous metastases can be confused with dermatitis. Their presence signals a poor prognosis. Case: A 66-year-old postmenopausal woman with a diagnosis of stage IVa cervical carcinoma was treated with radical concurrent chemotherapy and radiation. Two months after completing treatment, the patient noted maculopapular skin lesions in the lower abdomen. These were confirmed on biopsy as metastases from the cervical cancer. The cutaneous metastases progressed rapidly to involve the inguinal regions, vulva, and perineum. Further assessment ruled out metastases to other organs. Despite six courses of palliative combination chemotherapy, the patient’s disease progressed, and she died six months after the appearance of the cutaneous metastases. Conclusion: We reviewed the details of 47 reported cases of cutaneous metastases of cervical carcinoma. In the majority of these cases, patients presented within 10 years of initial diagnosis and died within a mean of 8.5 months from cutaneous metastasis. Résumé Contexte : Le cancer du col utérin se métastase à la peau chez < 2 % des patientes. Les métastases cutanées peuvent être confondues avec une dermatite. Leur présence indique un piètre pronostic. Cas : Une femme postménopausée de 66 ans présentant un diagnostic de carcinome du col utérin de stade IVa a été traitée au moyen d’une radiothérapie et d’une chimiothérapie radicales concomitantes. Deux mois à la suite de la fin du traitement, la patiente a constaté la présence de lésions cutanées maculopapulaires sur la partie inférieure de l’abdomen. La biopsie a permis de confirmer qu’il s’agissait de métastases issues du cancer du col utérin. Les métastases cutanées ont connu une évolution rapide pour en venir à affecter les régions inguinales, la vulve et le périnée. La tenue d’autres évaluations a permis d’écarter la présence de métastases affectant d’autres organes. Malgré la mise en œuvre de six périodes de polychimiothérapie palliative, la maladie de la patiente a poursuivi son évolution; celle-ci est décédée six mois à la suite de l’apparition des métastases cutanées. Conclusion : Nous avons analysé les détails des 47 cas signalés de métastases cutanées issues d’un carcinome du col utérin. Dans la plupart de ces cas, les patientes consultaient leur médecin dans les 10 ans suivant le diagnostic initial et décédaient dans un délai moyen de 8,5 mois à la suite de l’apparition de métastases cutanées. J Obstet Gynaecol Can 2010;32(5):467–472 Introduction T he incidence of metastasis to the skin from visceral cancer is less than 10% (0.7–9.0%). 1 Cutaneous metastasis in women mainly arises from breast, ovary, and colon cancer. 2–4 Carcinoma of the uterine cervix is relatively common, and it metastasizes most often to the lungs, the bones, and the liver. 1,2 Cervical cancer rarely metastasizes to the skin; this occurs in < 2% of patients. 2–5 Patients with cutaneous metastatic disease may present at the time of diagnosis or up to 10 years later. 6–8 The average reported survival is 8.5 months. 9 The presence of metastatic disease in the skin signals a poor prognosis, because skin metastasis is usually associated with local or regional recurrence. 1,5,7,9 The treat- ment is usually palliative. 1-3,6,9 The mechanism of metastasis can be understood as a series of steps providing three basic patterns of distribution: mechanical (arising from anatomical proximity and lymphatic draining), site-specific (arising from the selective attach- ment of tumour cells to a specific organ), and non-selective (independent of these distribution factors). 1 MAY JOGC MAI 2010 l 467 CASE REPORT Key Words: Cervical cancer, cutaneous metastasis, visceral cancer metastasis Competing Interests: None declared. Received on November 2, 2009 Accepted on December 23, 2009