암전문 3차의료기관 피부과에 내원한 고형암에 의한 전이피부암 191예의 임상 및 조직병리학적 고찰

박형건 ( Hyung Keon Park ),윤숙정 ( Sook Jung Yun ) 대한피부과학회 2023 대한피부과학회지 Vol.61 No.1

Background: Metastatic skin cancers occur when cancer cells metastasize to the skin as the primary cancer progresses, but few studies in Korea have included a large number of patients. Objective: To analyze the clinicopathological characteristics of metastatic skin cancers originating from solid cancers. Methods: A total of 191 patients with metastatic skin cancer diagnosed by skin biopsy from April 2004 to December 2021 were retrospectively analyzed. Data on age, sex, duration, symptoms, clinical manifestations, metastatic sites, and histopathological findings were obtained from medical records and photographs. Results: The mean age of onset was 65.3 years, the male/female ratio was 80:111, and the mean duration was 3.3 months. Most patients were asymptomatic (65.4%), and the most frequent manifestation was nodular lesions (64.4%). Among the 191 metastatic skin cancers, the most common primary cancers were breast cancer (31.9%), lung cancer (25.7%), and melanoma (18.8%). The most common primary cancer in males was lung cancer (52.5%), and that in females was breast cancer (54.1%). The most common sites of metastatic skin cancer were the chest (26.6%), scalp (17.9%), abdomen (10.6%), and back (9.2%). The most common histopathological finding of metastatic skin cancer was adenocarcinoma (53.4%), followed by melanoma (18.8%) and squamous cell carcinoma (14.7%). Conclusion: We believe that this study will be helpful in diagnosing metastatic skin cancer in patients with a history of cancer or a newly diagnosed primary cancer. (Korean J Dermatol 2023;61(1):13∼21)

Recent Trends (1991-2010) of Metastatic Skin Cancers in Korea

방철환,배정민,김혜성,김경문,유동수,박현정,오신택,강훈,박철종,이정덕,이준영,김형옥,박영민 대한의학회 2013 Journal of Korean medical science Vol.28 No.7

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women,and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.

피부 전이암의 임상 및 병리조직학적 소견

김승희 ( Kim Seung Hui ),전영승 ( Jeon Yeong Seung ),심형준 ( Sim Hyeong Jun ),서기석 ( Seo Gi Seog ),김상태 ( Kim Sang Tae ) 대한피부과학회 2004 大韓皮膚科學會誌 Vol.42 No.3

N/A Background: The incidence of metastatic skin cancer has been reported to be relatively low. Because the diagnosis is not so difficult, cutaneous metastasis could be an important clue to discover the hidden internal malignancy, if found before recognizing primary cancer, or play a significant role to determine therapeutical plans and prognosis if found after diagnosis of primary cancer. Material and methods: This study was made upon the 68 cases of metastatic skin cancer, which had been confirmed histopathologically in the department of dermatology, Kosin University Gospel hospital from January, 1986 to August, 2003. Age and sex distributions, sites of primary cancer, time of detection, localization of the lesions, morphologic and histopathologic findings were examined by the review of medical records, clinical photographs, and pathologic slides. Results: 1. The mean age at the time of diagnosis was 56.6 years and most patients were distributed over 5 decades. The male to female ratio was 1:1.3. 2. Metastasis from breast carcinoma consisted of 19 cases, this was the most common primary cancer, followed by lung cancer, melanoma, and stomach cancer. In men, lung cancer and stomach cancer were the most common primary neoplasm, while breast cancer was the most frequent in women. 3. 50 of the cases were detected after diagnosis of primary cancer and during therapy. The other 18 cases were detected before the internal malignancy was recognized. 4. The localization of metastatic skin cancer was widespread over the whole body. The majority of cutaneous metastasis was predisposed to the surface near primary cancer, but distant metastases 5. The most common morphologic features were single or multiple nodules, while inflammatory and indurated plaques were also found. 6. Histopathologic examination revealed that adenocarcinoma was the most common pathologic type, followed by squamous cell carcinoma and melanoma. The histopathologic features of cutaneous metastasis generally mimicked that of primary tumors. Conclusion: Generally, metastatic skin cancer is detected after the diagnosis of primary cancer showing subsequent treatment failure and poor prognosis. In some cases, however, cutaneous metastasis can be the earliest sign to recognize internal malignancy. Especially in the cases of metastatic skin cancer originating from the kidney, liver and thyroid gland, cutaneous features are the most significant evidences to presume the site of origin without any other findings. Therefore, it is important to recognize the clinical and histopathologic findings of metastatic skin cancer for the most successful diagnostic, therapeutic and prognostic determination. (Korean J Dermatol 2004;42(3):300~308)

Therapeutic Regimens and Prognostic Factors of Brain Metastatic Cancers

Song, Wen-Guang,Wang, Yi-Feng,Wang, Rui-Lin,Qu, Yin-E,Zhang, Zhi,Li, Guo-Zhong,Xiao, Ying,Fang, Fang,Chen, Hong Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.2

Objective: This work aims to investigate the therapeutic regimen of brain metastatic cancers and the relationship between clinical features and prognosis. Methods: Clinical data of 184 patients with brain metastatic cancers were collected and analysed for the relationship between survival time and age, gender, primary diseases, quantity of brain metastatic foci, their position, extra cranial lesions, and therapeutic regimens. Results: The average age of onset was 59.1 years old. The median survival time (MST) was 15.0 months, and the patients with breast cancer as the primary disease had the longest survival time. Females had a longer survival time than males. Patients with meningeal metastasis had extremely short survival time. Those with less than 3 brain metastatic foci survived longer than patients with more than 3. The MST of patients receiving radiotherapy only and the patients receiving chemotherapy only were all 10.0 months while the MST of patients receiving combination therapy was 16.0 months. Multiple COX regression analysis demonstrated that gender, primary diseases, and quantity of brain metastatic foci were independent prognostic factors for brain metastatic cancers. Conclusions: Chemotherapy is as important as radiotherapy in the treatment of brain metastatic cancer. Combination therapy is the best treatment mode. Male gender, brain metastatic cancers originating in the gastrointestinal tract, more than 3 metastatic foci, and involvement of meninges indicate a worse prognosis.

Metastatic Bone Disease as Seen in Our Clinical Practice - Experience at a Tertiary Care Cancer Center in Pakistan

Qureshi, Asim,Shams, Usman,Akhter, Azra,Riaz, Sabiha Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.9

Aim: Metastatic tumor of bone is the most common malignancy involving bone and is an important predictor of prognosis in advanced cancers. The prognosis depends upon the primary site of origin and the extent of disease. In current study, we present the pattern and distribution of metastatic bone disease seen in the leading cancer care center of Pakistan, Shaukat Khanum Cancer Hospital & Research Center (SKMCH & RC), Lahore. Materials & Methods: All cases of bony metastatic disease were included that presented in the Pathology Department, from Jan 2005 to July 2011. Patients of all ages and both sexes were included. Primary bone tumors, lymphomas, sarcomas and other malignancies were excluded. The data were recorded and analyzed with SPSS 16.0. Results: A total of 146 cases of metastatic bone disease were included in the study. Out of the total cases, 79 were male and 67 were female. Age range 25-82 years (median 52). Hip bone was the most frequent bone involved, with femur and vertebrae as second and third in the list. The commonest bone involved in males was vertebrae with 23 cases and in females was hip bone with 22 cases. Regarding primary site, cancers of breast, prostate and gastrointestinal tract were at the top of the list with prostate and breast being the most frequent primary sites of metastasis in males and females respectively. Conclusion: Bone metastasis is an important entity to consider in the differential diagnosis whenever a bony tumor especially carcinoma present in older age. Our data are comparable with international findings and the literature available regarding the site and distribution of skeletal metastatic lesions. A slight deviation noted was more common bony metastatic lesions with ovarian primaries in females and gastrointestinal tract cancers in males in our study.

Metastatic colon cancer cell populations contain more cancer stem-like cells with a higher susceptibility to natural killer cell-mediated lysis compared with primary colon cancer cells

KIM, GA RIM,HA, GA-HEE,BAE, JAE-HO,OH, SAE-OCK,KIM, SUN-HEE,KANG, CHI-DUG D.A. Spandidos 2015 Oncology letters Vol.9 No.4

<P>In the present study, the soft agar clonogenicity and the susceptibility of clonogenic cancer cells to natural killer (NK) cells were compared between primary colon cancer cells (KM12C) and metastatic colon cancer cells (KM12L4a and KM12SM) to determine whether the metastatic cancer cells consisted of more cancer stem-like cells and were resistant to NK cell-mediated lysis. The majority of colon cancer cells were positive for putative cancer stem cell markers, including CD44, CD133 and EpCAM, with the exception of KM12C cells, of which only ~55% were positive for CD133. In addition, the expression levels of sex determining region Y-box 2, Nanog and octamer-binding transcription factor 4, which are essential for maintaining self-renewal, were higher in KM12L4a and KM12SM compared with that in KM12C cells. Consistently, an increased clonogenicity of KM12L4a and KM12SM compared with KM12C cells in soft agar was observed. The expression levels of NKG2D ligands, including major histocompatibility complex class I polypeptide-related sequence A/B and UL16 binding protein 2, and of death receptor 5 were significantly higher in KM12L4a and KM12SM than in KM12C cells. Furthermore, the results indicated an increased susceptibility of KM12L4a and KM12SM to NK cell-mediated cytotoxicity in comparison with KM12C cells. These results indicated that metastatic colon cancer cell populations may consist of more cancer stem-like cells, and have greater susceptibility to NK cell-mediated lysis compared with that of primary colon cancers.</P>

Dermoscopic findings of metastatic skin cancers: a single center experience

( Geun-hwi Park ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Though skin metastasis is rare, it can seriously affect the prognosis and management. The role of dermoscopy in primary skin cancers are established well, but its role in skin metastasis hasn’t been clear. Objectives: This study was performed to elucidate the dermoscopic patterns of metastatic skin cancers. Methods: We analyzed the dermoscopic patterns and clinical data of 46 patients with metastatic skin cancers at Pusan National University Hospitals (Busan and Yangsan) from 2005 to 2018. Results: Mean age and disease free interval were 62.0±14.2 years and 29.2±41.2 months, respectively. The most common primary origin of cancer was breast (11/46, 23.9%), followed by lung (8/46, 17.4%), and upper gastrointestinal tract (8/46, 17.4%). Any dermoscopic patterns was not found in 8 cases, who showed subcutaneous nodules without surface change. Most common dermoscopic pattern was vascular pattern (30/46, 65.2%), followed by homogenous structureless pattern (16/46, 34.8%). Most common vascular pattern was serpentine and arborizing vessel (23/46, 50%), followed by dotted vessel (7/46, 15.2%). There was no significant difference in dermoscopic vascular pattern among cancers, because the number of subjects was insufficient. Conclusion: Based on our study, when vascular patterns such as serpentine and arborizing vessel or dotted vessel are seen on dermoscopy within a nodule in a patient already diagnosed with cancer, metastatic skin cancer should be strongly considered.

위암에서 근치적 절제술 후 전이 림프절 수가 예후에 미치는 영향

임호영,최진혁,김현수,남동기,김효철 아주대학교 의과학연구소 1998 아주의학 Vol.3 No.1

Gastric cancer is the most common cause of cancer death in Korea, and the most important prognostic factor for patients with gastric cancer is the extent of TNM stage. Among TNM staging system, lymph node involvement (N) has been recognized as one of the significant prognostic indicators after curative resection. Recently, nodal stage of new AJCC TNM staging system has changed its emphasis on the location of metastatic lymph nodes to the number of metastatic lymph nodes. Thus, we attempted to analyze the survival difference based on the number of metastatic lymph nodes after curative resection of gastric cancer. Two hundred and forty two patients of curatively resected gastric cancer were retrospectively studied to identify the number of metastatic lymph nodes to influence prognosis. The following results were obtained. The results showed that there was a significant difference in the survival rate between the patients with 0-2 metastatic lymph nodes and those with ≥3 metastatic lymph nodes in adjuvant chemotherapy (FA) group (DFS; 36.7% vs. 23.4%, OS; 38.3% vs. 26.0%). In adjuvant chemoimmunotherapy (FA+poly-AU) group, there was a significant difference in the overall survival between the patients with 0∼2 metastatic lymph nodes and those with ≥ 3 metastatic lymph nodes(70.1% vs. 47.4%). The present report demonstrates the prognostic importance of the number of metastatic lymph nodes in gastric cancer after curative resection and a necessity of further evaluation of current nodal stage.

Living Experiences of Male Spouses of Patients with Metastatic Cancer in Taiwan

Lin, Hui-Chen,Lin, Wen-Chuan,Lee, Tzu-Ying,Lin, Hung-Ru Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: Cancer is the leading cause of death in Taiwan. Spouses are generally the main caregivers of affectyed patients but previous studies have seldom investigated the needs of male spouses of patients with metastatic cancer. Purpose: To explore the lived experiences of such male spouses. Methods: A qualitative design using in-depth interviewswasconducted with male spouses of patients with metastatic cancer being treated at the oncology outpatient department in a teaching hospital in northern Taiwan. Results: Nine participants aged 31-78 were interviewed. Content analysis of the interviews revealed five themes: suffering and struggling, difficulty in focusing on communication and interaction, shouldering responsibility, cherishing the love between husband and wife, and enabling each other to live better. This study demonstrated how male spousse experienced physical and psychological suffering when their wives suffered from metastatic cancer. They had to bear the pain of their wife's suffering, and also had to shoulder the responsibility for everything. All their efforts were put towards enabling each other to live a better life. They cherished the rest of the time they could spend with their wives, even though they had to live a hard life. As the male spouses of patients with metastatic cancer, the participants exhibited both the masculinity of men and the ability to express care and tenderness. Conclusions: The results showed that male spouses need more attention in terms of communication and bearing with suffering. Health care professionals should more actively understand the needs and provide assistance when facing the male spouse of patients with cancer, so as make sure that they possess the ability to take care of their wives. Health care professionals should also assist and properly act as a bridge of communication between husbands and wives.

CASE REPORT : Small Bowel Metastatic Cancer Observed With Double Balloon Enteroscopy in a Patient With a Past History of Multiple Cancers

( Ji Young Song ),( Beom Jae Lee ),( Eun Sang Yu ),( Young Ju Na ),( Jong Jae Park ),( Jae Seon Kim ),( Young Tae Bak ) 대한장연구학회 2015 Intestinal Research Vol.13 No.4

Small bowel tumors are very rare and generally malignant. As a result of the anatomical location and nonspecific manifestations of small bowel tumors, they are very difficult to diagnose. Balloon-assisted enteroscopy is a relatively noninvasive method compared to surgical resection, and allows for real-time observation, tissue confirmation with biopsy, and interventional procedures. Here, we report the case of a 69-year-old woman with a small bowel metastatic carcinoma observed with double balloon enteroscopy (DBE). She had a history of multiple cancers including ovarian cancer, bladder cancer, and breast cancer. The antegrade DBE procedure was performed before surgery for biopsy tissue confirmation. The patient underwent small bowel resection, and the final diagnosis was the same as that determined by preoperative biopsy. The final diagnosis was metastatic small bowel cancer originating from a cancer of the breast. This is the first detailed report of the preoperative diagnosis of small intestinal metastatic breast cancer by DBE. (Intest Res 2015;13:350-354)