Skin metastases

Introduction The skin is one of the common metastatic sites of various malignant tumors. Metastatic skin cancer can occur in any age group, but most of them occur in 40 to 70 years old. The chest wall, armpits and abdomen are the predilection sites of skin metastases. Primary lung cancer is insidious, especially in peripheral lung cancer, which often lacks typical respiratory symptoms, and is often delayed in diagnosis. Sometimes subcutaneous metastases may be the only feature of lung cancer.

Cause

Skin metastases accounted for 2.7% to 4.4% of metastatic tumors, female patients were mostly from breast cancer (about 69%), followed by colorectal cancer (9%), and 4% to 5 from lung cancer, ovarian cancer and malignant melanoma. %.

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Related inspection

Immunopathological examination of fungal histopathology

He was diagnosed with subcutaneous nodules and confirmed by X-ray and pathological examination. The skin of the metastatic lesion is mostly reddish, which is a painless round nodule or mass. It is higher than the skin, the texture is hard, the surface is smooth, no ulceration, and the activity is poor, the diameter is 1.5-7.0cm.

Clinically, in the case of painless subcutaneous nodules of unknown origin, pathological sections of subcutaneous nodules should be performed in time. For cancerous lesions, chest X-ray or CT examination should be performed in time to determine whether the primary lesion is lung.

Differential diagnosis

Pleural metastasis: mainly from the lungs, followed by the breast, other common primary sites are the stomach, ovary, pancreas and so on. Cancer causes pleural capillary pressure, colloid osmotic pressure, capillary permeability and intrathoracic pressure changes, resulting in pleural effusion, malignant pleural effusion. Malignant pleural effusion, also known as cancerous pleurisy, is a pleural effusion caused by cancer pleural metastasis and pleural cancer itself. Malignant pleural effusion is a common complication of advanced cancer. Once a pleural effusion occurs in a cancer patient, it means that the lesion has spread locally or in the body.

Pericardial metastasis refers to the result of metastasis of other parts of the malignant tumor to the pericardium. Pericardial metastases are one of the systemic manifestations of malignant tumors.

1. Pericardial metastases mainly cause acute exudative pericarditis, but are usually asymptomatic. Most were found by chance only during autopsy. However, it is one of the common causes of acute pericarditis in developed countries. In some patients with undiagnosed malignant tumors, leukemia, etc., tamponade may be the earliest manifestation.

2. Dyspnea is the most common symptom.

Pulmonary metastasis: generally refers to the deterioration of malignant tumors and metastasis to the lungs. The lung is the only place for systemic blood flow, and its abundant capillary bed is a high-efficiency filter, which is a good site for the metastasis of various malignant tumors. 20 to 54% of people who die of malignant tumors have lung metastasis, and 15% of the lungs are the only metastatic site. The occurrence of lung metastases is generally thought to be that the tumor cells stay in the bifurcation of the small arteries or capillaries of the lungs, adhere to the endothelium of the capillaries to form a clot, and pass through the wall of the tube into the connective tissue outside the blood vessels, and then the cells Hyperplasia, becoming a small tumor, forming metastatic tumors.

Cardiac metastasis: refers to the transfer of systemic malignant tumors to the heart through various routes. Here, a tumor is formed and called a cardiac metastasis, which was first reported by Heketoen in 1893. Compared with liver, lung or brain, tumors have less probability of metastasis to the heart, and clinical manifestations are often inconspicuous, but their significance is related to their ability to resemble more common heart diseases and sometimes fatal due to cardiac metastasis.

Lymphatic metastasis: It is the most common form of metastasis of cancer. It refers to the invasion of tumor cells through the lymphatic wall. After shedding, the lymph fluid is brought to the lymph nodes of the confluence area, and the same tumor is grown as the center. Lymph node metastasis usually begins with the first set of lymph nodes closest to the tumor, and then to the distant distance. When the tumor cells infiltrate and grow at each station, they also spread to adjacent lymph nodes in the group. However, there are exceptions. In some patients, it is also feasible to bypass the lymph nodes in the pathway to directly transfer to distant lymph nodes. The mode of clinical transfer is called a jump transfer. These features increase the complexity of tumor metastasis, resulting in clinical lymph node metastasis that is difficult to find the primary lesion.

Bone metastasis: It is the transfer of some primary diseases through the blood. Breast cancer is the cancer most prone to bone metastasis. Breast cancer is the most common malignant tumor in the female breast, and it is also one of the most common malignant tumors in women. Cancer patients may have bone metastases in cancer when they have symptoms of bone pain.

He was diagnosed with subcutaneous nodules and confirmed by X-ray and pathological examination. The skin of the metastatic lesion is mostly reddish, which is a painless round nodule or mass. It is higher than the skin, the texture is hard, the surface is smooth, no ulceration, and the activity is poor, the diameter is 1.5-7.0cm.

Clinically, in the case of painless subcutaneous nodules of unknown origin, pathological sections of subcutaneous nodules should be performed in time. For cancerous lesions, chest X-ray or CT examination should be performed in time to determine whether the primary lesion is lung.

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