CUTANEOUS METASTASES FROM TRANSITIONAL CELL CARCINOMA OF THE BLADDER CRAIG A. BLOCK, LAILA DAHMOUSH, AND BADRINATH R. KONETY ABSTRACT Cutaneous metastases from primary genitourinary malignancies are rare and usually represent a poor prognostic sign. Very few cases of skin metastases from urothelial carcinoma have been reported in the past, and most of them were treated with chemotherapy. We report a patient with transitional cell carcinoma of the bladder who developed skin metastases after cystectomy. The lesions did not respond to systemic chemotherapy but resolved with local radiation therapy. We discuss the need to have a high index of suspicion to identify these lesions and the treatment approaches. UROLOGY 67: 846.e15–846.e17, 2006. © 2006 Elsevier Inc. T he overall incidence of cutaneous metastasis from primary solid visceral malignancies is 2.9% to 5.3%. 1,2 The most common site of metas- tasis is the chest, whereas breast cancer is the most common pathologic subtype, with an inci- dence of 24%. The incidence of cutaneous metas- tasis from all urologic malignancies is 1.1% to 2.5%. Metastasis to the skin from renal cell carci- noma is the most common (3.4% to 4.0%), fol- lowed by bladder (0.84% to 3.6%), prostate (0.36% to 0.7%), and testis (0.4%) tumors. We present a case of cutaneous metastasis from transitional cell carcinoma (TCC) of the bladder, which was treated with local radiation with a good result. CASE REPORT A 59-year-old Hispanic man presented with a 3-month history of two tender purple nodules on his back (Fig. 1). The nodules were initially thought to be furuncles. They continued to enlarge, becom- ing increasingly painful. Past medical history was remarkable for bladder cancer, for which the pa- tient had undergone radical cystoprostatectomy 7 months earlier, which revealed node-positive dis- ease. He subsequently developed bony metastasis to multiple long bones and soft tissue metastases in the right flank, as well as retroperitoneal lymphad- enopathy. He failed systemic chemotherapy with gemcitabine and cisplatin, with no response being observed in the soft tissue lesions in the flank, ret- From the Departments of Urology and Pathology, University of Iowa, Iowa City, Iowa Address for correspondence: Badrinath R. Konety, M.D., De- partment of Urology, UCSF—Mt. Zion Medical Center, 1600 Divisadero A624, Box 1695, San Francisco, CA 94143. E-mail: bkonety@urology.ucsf.edu Submitted: June 4, 2005, accepted (with revisions): October 25, 2005 FIGURE 1. Cutaneous metastatic nodules of TCC aris- ing in the bladder at presentation. CASE REPORT © 2006 ELSEVIER INC. 0090-4295/06/$32.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.10.045 846.e15