폐암의 피부전이의 유병률 조사와 임상 및 병리조직학적 연구

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),장성은(Sung Eun Chang),최정철(Jung Chul Chol) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.6

N/A Background: Cutaneous metastasis from lung cancer is rarely seen in dermatologic clinics although the lung is the most common source of cutaneous metastasis in men. There is much variation of the prevalence of lung cancer and its cutaneous metastasis among different countries and with time. Objective : Our purpose was to study prevalence, relative frequency of pathological subtypes and clinical features of cutaneous metastasis from lung cancer in Korea. Methods : We utilized a computer system in order to analyze the incidence of cutaneous metastasis from lung cancer during the 10-year period from 1990 to 1999 in Asan Medical Center. Clinical records, clinical photographs, and biopsy slides of the biopsy-proven cases were reviewed. Results: 1. Of the 4635 patients with lung cancer, 2954(63.7%) had metastatic diseases and 83(1.8%) had skin metastasis. Of the 2954 metastatic diseases, skin metastasis was only 2.8%. Of the total 83 patients, male to female sex ratio was 3.9:l. 2. Of the 33 proven cases by dermatologists, 8(24%) contributed to detect bidden primary lung cancer. While 23(69.7%) cases had other internal metastasis, detection of skin metastasis preceded other metastasis in 30.4%. 3. Most frequently the chest was involved, followed by the scalp. 4. Of the pathologically-proven 55 cases, 23 cases showed adenocarcinomas, 20 cases squamous cell carcinomas, 8 cases small cell carcinomas, 3 cases large cell carcinomas, and 1 case undifferentiated carcinoma. Conclusion : Although skin metastasis from lung cancer is less common than other organs, diagnosis of skin metastasis is important since it can manifest as a presenting sign of internal malignancy and an early indicator of metastasis. (Korean J Dermatol 2001;39(6) 660~665)

P280 : Role of matrix metalloproteinase in cutaneous metastasis of internal malignancy

( Tae Hyung Kim ),( Mi Ryung Roh ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Among the matrix metalloproteinase (MMP), MMP-2, -9, tissue inhibitor of metalloproteinase (TIMP)-2 and membrane type 1 matrix metalloproteinase (MT1-MMP) are thought to be involved in the process of destruction of basement membranes and stromal invasion by cancer cells. Objectives: To investigate the role of MMP and TIMP in cutaneous metastasis of internal malignancy, we compared the expression of MMP-2, MMP-9, MT1-MMP and TIMP-2 between internal malignancy and cutaneous metastasis. Methods: We collected the clinical information of patients with cutaneous metastasis of internal malignancy and biopsy specimens from internal malignancy and cutaneous metastasis. And we evaluated the expression of MMP-2, MMP-9, MT1-MMP and TIMP-2 in internal malignancy tissues and cutaneous metastasis tissue using immunohistochemical staining. Results: We found that cutaneous metastasis showed statistically significant increase in the expression of MMP-2, MMP-9 and MT1-MMP and statistically significant decrease TIMP-2 compared to internal malignancy.In the each type of internal malignancy, breast cancer, lung cancer, stomach cancer, colon cancer, renal cancer, expressions of MMPs and TIMP showed similar pattern. Conclusion: We suggest the pathogenesis of cutaneous metastasis from internal malignancy through MMP and TIMP. This study would provide targets for the development of new therapeutics to prevent cancer metastasis and suggest individualized treatment according to type of cancer.

FC 2-3 : Clinical application of computed tomography evaluating metastasis in patients with non- melanomatous cutaneous malignancies

( Ju Yeon Choi ),( Han Saem Kim ),( Jung In Kim ),( Jung Min ),( Hyun Min Seo ),( Sang Hyeon Hwang ),( Heun Joo Lee ),( Yoon Hwan Kim ),( Ho Joo Jung ),( Jae Hui Nam ),( Ji Hye Park ),( Ga Young Lee ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: According to the increasing incidence of malignant cutaneous neoplasm and life expectancy, evaluating metastasis is getting important factor in treatment. Computed tomography (CT) is the most common initial imaging technique and is useful for evaluating tumor extent, depth of invasion and distant metastasis. Objectives: The aim of this study was to compare the efficacy of CT in detecting metastasis for the non-melanomatous cutaneous malignancies. Methods: We carried out regional CT for evaluation of non-melanomatous cutaneous malignancies in the patients who had been diagnosed in the Kangbuk Samsung hospital from January 2009 to July 2014. Results: CT was performed on 129 patients and there were 3 cases of metastasis. 2 cases were high risk squamous cell carcinoma (SCC) among 37 SCC cases. One case was a patient showing multiple basal cell carcinomas (BCC) on face among 74 BCC cases and there was no metastasis risk factor including large tumor size, deep structure invasion, et cetera. All metastatic lesions were regional lymph nodes. Conclusion: This study revealed that CT is recommended for the high risk SCC patients and BCC patients who show multiple lesions. There is no gold standard radiologic study for evaluating metastasis in non-melanomatous cutaneous malignancies. However, considering low distant metastasis rate of those, CT can be the best initial radiologic study.

A rare case of cutaneous metastasis of papillary thyroid cancer

( Gayun Baek ),( Taehan Koo ),( Eunjung Park ),( Mingyul Jo ),( Jiho Park ),( Mihn-sook Jue ),( Min-soo Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Distant metastasis of PTC have been reported to be between 4% and 23%, although the metastasis to the skin is reported be less 1%. Clinical presentation of skin metastasis of papillary thyroid cancer is variable, including patch, plaque, nodule, or papule. A 85-year-male presented asymptomatic solitary 0.5 cm-sized pinkish nodule on right parietal scalp. The patient had medical history of papillary thyroid cancer which was treated with total thyroidectomy. After surgery, the patient had palliative radiotherapy and chemotherapy due to recurred PTC with multiple lung metastasis. Skin biopsy specimen showed tumor cells with papillary configurations consist of cuboidal epithelial cells. Immunohistochemical staining showed TTF-1 positive which suggests the cells were derived from thyroid gland. Based on medical history and histopathologic findings, we diagnosed cutaneous metastasis of PTC. The patient treated with supportive care and expired 10 months after diagnosis. Cutaneous metastasis of PTC is reported less than 1 in 1,000 patients. So we herein report a rare case of cutaneous metastasis of papillary thyroid cancer.

The Expression of NMDA Receptor 1 Correlates with Clinicopathological Parameters in Cutaneous Squamous Cell Carcinoma

( Min Ju Kang ),( Jae Hoon Cho ),( Ja Kyung Koo ),( Sun Up Noh ),( Mi Yeon Kim ),( Hoon Kang ),( Shin Taek Oh ),( Hyung Ok Kim ),( Young Min Park ) 대한피부과학회 2009 Annals of Dermatology Vol.21 No.4

Background: Ionotropic glutamate receptors of the N-methyl-D-aspartate receptor (NMDAR) type are expressed on keratinocytes and play a role in the proliferation, differentiation, and cornification of keratinocytes. However, the expression profile of NMDAR and its role in cutaneous malignancy is unclear. Objective: We analyzed the expression of NMDAR-1 in cutaneous squamous cell carcinoma (SCC) and investigated the relationship between NMDAR-1 expression and clinicopathological parameters. Methods: Thirty-two patients with biopsy-proven cutaneous SCC were enrolled in this study. Each patient was analyzed for tumor diameter, location, local recurrence, and metastasis by conducting a chart review. The SCC specimens were histologically divided into differentiated and undifferentiated groups based on Broders` system. NMDAR-1 expression was examined by performing immunohistochemistry, and the relative staining intensity in the SCCs was graded into 5 levels. According to the staining intensity of NMDAR-1, the specimens were categorized into two groups: the higher group and the lower group. Results: Fifteen (88%) of 17 tumors in the higher group were differentiated SCC, whereas 14 (93%) of 15 tumors in the lower group were undifferentiated SCC. In addition, NMDAR-1 expression was inversely correlated with metastasis (p=0.049). Local recurrence was associated with a lower staining intensity, but the results were not statistically significant. Conclusion: Our results demonstrate that NMDAR-1 expression in cutaneous SCC is significantly correlated with its differentiation and metastasis. Therefore, it may be a prognostic indicator for cutaneous SCC. (Ann Dermatol 21(4) 382~388, 2009)

Case Report : Breast Cancer Cutaneous Metastasis at Core Needle Biopsy Site

( Eu Jin Cho ),( Min Ho Kim ),( Sang Hee Cha ),( Sang Hyun Cho ),( Se Jeong Oh ),( Jeong Deuk Lee ) 대한피부과학회 2010 Annals of Dermatology Vol.22 No.2

Cutaneous metastasis from breast cancer can occur by direct invasion, lymphatic and vascular spread as well as iatrogenic implantation. Metastasis that occurs by iatrogenic implantation after needle biopsy is very rare but the potential risk must be considered. In this report, we describe a case of breast cancer cutaneous metastasis that occurred by iatrogenic implantation following core needle biopsy. A 53-year-old woman presented with a 1×1 cm sized erythematous nodule at the biopsy site after breast conserving surgery for primary cancer. Histopathological findings confirmed cutaneous metastasis. The possibility of this consequence must be considered when performing needle biopsies. (Ann Dermatol 22(2) 238~240, 2010)

피부 편평세포암 및 전이의 임상조직학적 관찰(2006∼2016)

송성은 ( Sung Eun Song ),노기웅 ( Ki Woong Ro ),허은필 ( Eun Phil Heo ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.3

Background: Cutaneous squamous cell carcinoma (cSCC) is a malignant proliferation of keratinocytes of the epidermis. It may have the potential to metastasize distally in contrast to the cutaneous basal cell carcinoma. Objective: We investigated the recent trend of cSCC development from a clinical, histopathological, and prognostic perspective. Methods: One hundred and sixty cases of cSCC in patients who had visited the Samsung Changwon Hospital over the past 10 years (between 2006 and 2016) were retrospectively studied. We analyzed their age, sex, location, etiologic factor, histopathologic finding, and treatment. Results: The average age of cSCC was 77 years old and the sex ratio was 1:2.27. The most commonly involved location was the head and neck (73.13%). The etiologic factors were unknown (61.88%), actinic keratosis (23.13%), Bowen`s disease (10.63%), burn scar (2.5%), chronic eczema (0.63%) and chronic inflammatory disease (0.63%). The average tumor diameter and thickness were 18.1 mm and 3.58 mm, respectively. The degrees of differentiation were well-differentiated (68.75%), moderately differentiated (28.75%) and poorly differentiated (2.5%). The occurrence rate of cSCC metastasis was 6.25% (10 cases/160 cases). The most common primary locations of cSCC metastasis were the lower extremities (5 cases/10 cases) and head and neck (2 cases/10 cases). All 10 cases were metastasis to adjacent lymph nodes. Five cases showed metastasis to distant lymph nodes, the lungs, liver or bone. The average tumor diameter and thickness of cSCC metastasis were 45.3 mm and 9.46 mm, respectively. Histopathologically, the degrees of differentiation were well-differentiated, moderately differentiated and poorly differentiated type (4 cases, 5 cases, and 1 case, respectively). Conclusion: The location of the lower extremities (p=0.000) and a size larger than 20 mm (p=0.000) were related to cSCC metastasis. cSCC metastasis was found at an average of 7.5 months after diagnosis. High-risk cSCC patients should be followed closely, particularly during the first 2 years after diagnosis. (Korean J Dermatol 2017;55(3):178∼185)

A case of skin metastasis of papillary thyroid carcinoma

( Dong Seok Shin ),( Ju Wang Jang ),( Dong Uk Cheon ),( Won Seon Koh ),( Jeong Eun Kim ),( Joo Yeon Ko ),( Young Suck Ro ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Metastatic thyroid carcinoma usually appears in local lymph nodes. Distant metastasis of papillary thyroid carcinoma (PTC) is uncommon but the sites usually include lung and bones when it occurs. Cutaneous metastasis from PTC is extremely rare and the incidence appears to be less than 0.1%. A 83-year-old man presented with solitary bluish nodule on his neck. He was diagnosed as papillary thyroid carcinoma after receiving fine-needle aspiration biopsy (FNAB) and had a total thyroidectomy with selective neck dissection 4 years ago. The skin lesion developed 3 months ago with no subjective symptom. The histopathologic examination showed a tumor mass located in upper dermis. The tumor was composed of cuboidal cells and contained eosinophilic colloid materials, which was consistent with papillary carcinoma. They were positively stained for cytokeratin-19 and Galectin-3. Based on these findings, it was diagnosed with cutaneous metastatic PTC. Herein, we report a rare case of cutaneous metastasis of PTC. In addition, there are several notable points in this case. The tumor occurred at the estimated FNAB insertion site and there was no evidence of lymphoid and neurovascular invasion, which was identified by negative results in CD31 and D2-40. These findings suggest that the route of metastasis may be a needle track rather than spontaneous metastasis.

대상포진양 폐암의 피부 전이

이진용 ( Jin Yong Lee ),신수정 ( Soo Jung Shin ),유창선 ( Chang Sun Yoo ),길민성 ( Min Seong Kil ),김철우 ( Chul Woo Kim ),김상석 ( Sang Seok Kim ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.4

Cutaneous metastasis is a relatively rare complication of internal malignancy and has been reported in 0.7% to 9% of all malignant cancers. It may be an important clue for undiagnosed malignancies or even the prognosis of primary cancers. Cutaneous metastatic cancers vary in type and are rarely presented with zosteriform distribution. The lung is one of the most common primary sites of zosteriform cutaneous metastasis. We describe a 52-year-old man with a prior history of lung cancer in whom zosteriform cutaneous metastasis developed along the right T4-5 dermatome on his trunk. This case highlights the importance of the differential diagnosis of cutaneous metastasis with zosteriform distribution and the need of skin biopsy in order to confirm the early diagnosis. (Korean J Dermatol 2013;51(4):272∼275).

A case of cutaneous metastasis of nasopharyngeal carcinoma on the face

( Min Kyun Ahn ),( Eun Hye Hong ),( Eun Byul Cho ),( Eun Joo Park ),( Kwang Ho Kim ),( Kwang Joong Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 52-year-old male was referred for solitary erythematous patch on the left cheek. He was diagnosed with nasopharyngeal carcinoma 3 years ago. And he was treated with Combined Cisplatin regimen chemotherapy and radiation therapy. 3 months after combined chemotherapy and radiation therapy, he found skin lesion on left cheek. Punch biopsy was performed because the relapse was suspected of occurrence in skin. The biopsy specimen showed nasopharyngeal carcinoma with positive EBV stain. Also he had multiple metastasis of nasopharyngeal carcinoma at medial canthal area, ethmoid sinus and sphenoid sinus on the computed tomographic image. He was transferred to oncologist and treated Gemcitabine regimen chemotherapy. Nasopharyngeal carcinoma is a unique head and neck malignant tumor with regard to its epidemiology, pathology, and prognosis. And it is common for distant metastasis to occur at other sites. The incidence of cutaneous metastasis is rare. Clinical manifestation of cutaneous metastasis is mainly single nodule on the penis, scalp, and neck. When skin metastasis develops, it suggests a progressive state of the disease. Herein, we experienced an uncommon case of nasopharyngeal carcinoma presenting cutaneous metastasis.