We report a 34 year old male patient who presented with subacute intestinal obstruction and skin nodules over the trunk which eventually proved to be metastases from multicentric adenocarcinoma of colon.

Introduction

Skin metastasis from intra abdominal malignancy
is rare and heralds a poor prognosis. Commonest primary site of skin metastasis is melanoma, breast and lung. Colon is a very rare primary site of skin metastasis.

Case Report

A 34 year old male patient presented with subacute intestinal obstruction since 3 days. Examination revealed abdominal distension with borborygmi but no signs of peritonitis or tachycardia. On general examination four skin nodules in front on the anterior chest wall and on the right side of upper back which were non tender and firm each measuring about 3 x 2 cm. Per rectal examination revealed a palpable circumferential growth about 7 cm from the anal verge.

Erect X-ray abdomen showed a few air-fluid levels. Haemogram and total leucocyte counts were normal. Patient was successfully managed conservatively for one week. CT scan of abdomen showed ileocaecal wall thickening and ascites.

Excision biopsy of the skin nodule showed metastatic cells from an adenocarcinoma. Colonoscopy revealed a growth at caecum and another in the ascending colon.

In view of the patient’s haemodynamic stability the patient was managed conservatively. Patient’s recovery was uneventful.

Discussion

Metastatic skin cancer is a rare complication of internal malignancy1 and that adenocarcinoma of colon is even rarer. The overall incidence of cutaneous metastasis arising from adenocarcinoma of colon is 0.5-0.9%.2,3 They manifest most commonly as nodules. Also cicatrical, bullous lesions, zosterifrom and umbilicus metastasis (sister Mary Joseph’s nodules) are also noted. Incisional or port-site metastasis are the other forms of presentation.2 The recognition of cutaneous metastasis often dramatically alters therapeutic plans. Tumours that have highest predilection for cutaneous metastasis are melanoma, breast and lung.3 The metastatic cells reach the skin via lymphatics, blood stream or umbilical remnants like urachus. They are easily diagnosed by FNAC or excisional biopsy. The median survival after cutaneous metastasis from adenocarcinoma of colon is about 4.4 months in one study.4 Cutaneous metastasis often heralds the terminal manifestation of primary tumour.5

References

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3. Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol 1990; 22 (1) : 19-26.
4. Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Survival after cutaneous metastasis: A study of 200 cases. Ann Dermatol Venereol 2001; 128 (12) : 1310-5.
5. Pak HY, Foster BA, Yokota SB. The significance of cutaneous metastasis from visceral tumours diagnosed by fine needle aspiration biopsy. Diagn Cytopathol 1987; 3 (1) : 24-9.