Dermatology Online Journal

Cutaneous metastases from carcinoma of the prostate: A case report
Rajeev Sharma MD, and Mithilesh Chandra
Dermatology Online Journal 11 (1): 24

Bishen Skin Centre, Aligarh , India

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Introduction

Between 2 percent and 9 percent of the visceral malignancies are responsible for cutaneous or subcutaneous metastases [1, 2, 3, 4]. Their presence is associated with advanced disease and poor prognosis. Malignancies of the breast, lung, kidneys, stomach, uterus, and colon are the most common causes for cutaneous metastases [5, 6]. Although carcinoma of the prostate is common [7], it is responsible for less than 1 percent of all skin metastases [6].

We describe a patient with carcinoma of the prostate and skin metastases on the face, neck, and upper chest, mimicking trichoepithelioma.

Case report

Figure 1
Papulonodules around the nose

A 64-year-old man develops multiple papules and nodules on the face 2 months prior. Existing lesions gradually increase in size, and new lesions appear on the neck and upper chest within 15 days of his examination. He has been diagnosed with carcinoma of the prostate about 5 years before, when he was admitted for urinary retention. A transurethral resection of the median lobe of the prostate was done, and histology of the resected tissue revealed adenocarcinoma. He did not return for followup in urology clinic because his urine stream was normal. At the time of presentation, he was not on any medication.

On examination, he is an otherwise healthy man with multiple skin-colored dome-shaped papules and papulonodules around the nose and adjoining face (Fig. 1). Similar lesions are present on the forehead, sides of the face (Fig. 2), neck, and upper chest (Fig. 3). A biopsy of a nodule on the neck reveals infarcted tumor tissue constituting glandular acini of malignant cells; occasional glands have viable-appearing nuclei (Figs. 4 and 5). His serum biochemistry reveals markedly increased levels of serum acid phosphatase (142 KAU) and prostate-specific antigen (121 units). He denies any further investigations and is lost to followup.

Figure 2	Figure 3
Papulonodules on the chest, neck and face.

Figure 4	Figure 5
Glandular tissue forming acini (H&E 140 ×)

Discussion

In a series of 2,200 autopsies, skin metastases are found to be present in 58 cases. Only one of them has carcinoma of the prostate [5]. Brownstein and Helwig [6] find three cases of carcinoma of the prostate metastasizing to the skin. In 961 patients with prostate carcinoma, Held and Johnson are able to identify only three cases of skin metastases [1]. In a series of 2,300 autopsies of patients with an internal malignancy, Reingold identify skin metastases from prostate carcinoma in three cases [8]. In two series of 500 and 426 patients, no patient with carcinoma of the prostate has skin metastases [4, 9].

Cutaneous metastases from prostate carcinoma are usually asymptomatic and may occur at single or multiple sites [10]. The lower abdomen, genitalia, and thighs are most often involved [11, 12, 18]. The head is also a common site for metastases [5, 19, 20, 21]. Metastatic lesions are usually papules or nodules (as in our patient), and they rarely ulcerate [21]. They may have a zosteriform distribution [22] or mimic pyoderma [23]. The lesions in our patient resembled trichoepitheliomas.

Prostate carcinoma is usually adenocarcinoma and has a high metastatic potential. It usually spreads to bones, liver, and lungs [11]. Spread occurs either contiguously or via lymphatics or blood vessels; it often occurs through the vertebral-venous system [14]. The mechanism of skin involvement is not well understood [14], but suggested routes include embolization of the vessels [11, 24], dissemination via lymphatics [25], and spread through perineural lymphatics [22].

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