Clinical Course

It is rare to find cancer of any of the organs metastasizing to the skin, but this does occasionally happen. Kauf-mann-Wolf* has recently written a very complete article on the subject, and has collected all of the published cases, sixty-five in number. It is to this article that the author owes the following statements.

The condition is very rare. Riechelmann,* in autopsies upon 711 carcinomatous subjects, did not once encounter this condition, Buday* found it three times in 366 cases, while Krasting* mentions seven instances of cutaneous metastases in 1,078 carcinoma cases, four of these, however, being associated with mammary cancer.

Out of the sixty-five cases that Kaufmann-Wolf has collected, twenty-three followed cancer of the stomach; three cancer of the liver; two, cancer of the pancreas; ten, cancer of the uterus; one, cancer of the ovary; six, cancer of the lung; two, cancer of the mediastinum; two, cancer of the esophagus, while the remainder sprang from various other organs. Twenty-three of the patients were men; thirty-three were women, while in the other instances the sex was not stated. Many of the patients were extremely old, but some were comparatively young, so it is improbable that age is a factor.

In only one or two instances was there a solitary metastasis to the skin; in the majority of instances the condition was simply associated with a general carcinomatosis. In the skin there are three forms of tumors-solitary nodules, groups of nodules, and a flat infiltra-ing form of neoplasm. The tumors are rather prone to early ulceration, except in those cases where the pathology showed the condition to be one of lymphatic infarction.

*Kaufmann-Wolf: Arch. f. Dermat. u. Syphil., 1913, cxiv, 709. 8 Riechelmann: Berl. klin. Wchnschr., 1902, 728, 758.

*Buday: Zeitschr. f. Krebsforschung, vi, 26. *Krasting: Zeitschr. f. Krebsforschung, iv, 336.

In some of the instances the patient died very soon after the appearance of the cutaneous manifestations, but the average duration of life after cutaneous metastases had taken place was about six months. One patient lived for one and a half years.

As accompaniments or prodromal symptoms there were found edema, herpes zoster-like vesicles, erysipeloid erythema, lichenoid conditions, and urticarial phenomena. With lymphatic infarction the edema was rather constant. Itching was often complained of.

Pathology

The type of cancer found in the skin depends on the nature of the primary growth.

Treatment

Treatment consists in keeping the patient comfortable.