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Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 1  |  Page : 113-114
Cutaneous metastasis of hormone therapy-resistant prostate adenocarcinoma to the inguinal region


1 Manisa Celal Bayar University, Faculty of Medicine, Department of Dermatology, Manisa, Turkey
2 Department of Pathology, Manisa, Turkey
3 Department of Urology, Manisa, Turkey

Date of Web Publication1-Feb-2021

Correspondence Address:
Aylin Türel Ermertcan
Manisa Celal Bayar University, Faculty of Medicine, Department of Dermatology, Manisa
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_420_19

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How to cite this article:
Cetinarslan T, Ermertcan AT, Temiz P, Müezzinoğlu T. Cutaneous metastasis of hormone therapy-resistant prostate adenocarcinoma to the inguinal region. Indian J Dermatol 2021;66:113-4

How to cite this URL:
Cetinarslan T, Ermertcan AT, Temiz P, Müezzinoğlu T. Cutaneous metastasis of hormone therapy-resistant prostate adenocarcinoma to the inguinal region. Indian J Dermatol [serial online] 2021 [cited 2021 Mar 2];66:113-4. Available from: https://www.e-ijd.org/text.asp?2021/66/1/113/308501




Dear Editor,

Adenocarcinoma of the prostate gland is the second most common malignancy in males, and it is well known to disseminate to bones, lymphatic nodes, and viscera. Skin metastases of prostatic origin are quite uncommon. The combination of clinical history, physical examination, laboratory tests, and routine pathology can often provide enough information for a conclusive diagnosis of metastatic prostatic adenocarcinoma.[1]

Herein we present an 86-year-old male patient with cutaneous metastasis of hormone therapy-resistant prostate adenocarcinoma to the inguinal region.

An 86-year-old man presented with 1-month history of multiple asymptomatic genital lesions. On dermatological examination, there were multiple erythematous papulonodules measuring 1–5 cm in diameter on the pubic and inguinal region [Figure 1]. The patient had been followed up with the diagnosis of prostate adenocarcinoma at the Urology Department for 15 years. The patient was consulted with us for the development of skin lesions. He was receiving leuprolide acetate subcutaneously every 3 months and bicalutamide 50 mg daily. His prostate-specific antigen (PSA) level was 6.9 ng/mL (N: 0–4 ng/mL) and free-PSA was 5.43 (N: 0–1). Other physical examination findings and laboratory investigations were normal. There was no lymphadenopathy on inguinal ultrasonography and no distant metastasis was detected on the other radiological examinations. A punch biopsy was performed from the lesion. Histopathological examination showed infiltration of the dermis by tumor cells arranged in a glandular pattern [Figure 2]. Immunohistochemical staining was positive for pancytoceratine (PanCK) and prostate-specific acid phosphatase (PSAP) [Figure 3]. The diagnosis was skin metastasis of prostate adenocarcinoma. Docetaxel treatment was started and medicated for six cycles. Local radiotherapy was performed. Significant improvement was achieved in skin metastases.
Figure 1: Multiple erythematous papulonodules variable in size on the pubic and inguinal region

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Figure 2: Epithelial tumor with small adenoid structures and cribriform areas in dermis (HE x40)

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Figure 3: PSAP positivity confirming the diagnosis of prostate adenocarcinoma (PSAP x40)

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Cutaneous metastases of internal malignancies are uncommon, with rates ranging from 0.6% to 10%. Cutaneous spread of prostate cancer is very rare, representing less than 1% of all cutaneous metastasis. Cutaneous metastases from prostatic carcinoma are usually asymptomatic and may occur at single or multiple sites. Metastatic lesions are usually papules and nodules and they rarely ulcerate. The cutaneous lesions presented as multiple hard nodules in 56 cases (72%), a single nodule in 11 (14%), edema or lymphedema in 5 (7%), and unspecific rash in 5 (7%). The most frequent site for the cutaneous involvement was inguinal area and penis (28%), followed by abdomen (23%), head and neck (16%), chest (14%), extremities (10%), and back (9%).[2]

Although the mechanism of cutaneous involvement is not well-understood, suggested routes include embolization of vessels, dissemination through lymphatics, and through perineural lymphatics. Immunohistochemistry is an important tool in establishing the organ of origin when histology is not conclusive.[3] A large majority of metastatic adenocarcinomas are P501S positive (99%). A small subset of metastatic prostatic adenocarcinoma shows significant differences in staining intensity and extent of PSA and P501S and therefore combined use of these markers may result in increased sensitivity for detecting prostatic origin.[4]

Therapeutic options reported for similar cases of prostatic carcinoma with cutaneous metastasis are primarily palliative and include tumor excision, radiation, intralesional chemotherapy (i.e., leuprolide), and treatment of the primary neoplasia.[5] Other chemotherapy options may be used, as in our patient. We observed a significant regression of the skin metastases with docetaxel.

Skin metastasis generally occurs in advanced malignancy, but it can be seen alone without distant metastasis as in our patient. Although cutaneous metastasis is an uncommon presentation of prostate cancer, in rapidly growing cutaneous nodules, especially on the perineal region, prostate carcinoma should be kept in mind.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Azafia JM, de Misa RF, Gomez MI, del Hoyo JF, Ledo A. Cutaneous metastases from prostatic cancer. J Dermatol 1993;20:786-8.  Back to cited text no. 1
    
2.
Wang SQ, Mecca PS, Myskowski PL, Slovin SF. Scrotal and penile papules and plaques as the initial manifestation of a cutaneous metastasis of adenocarcinoma of the prostate: Case report and review of the literature. J Cutan Pathol 2008;35:681-4.  Back to cited text no. 2
    
3.
Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: A clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol 2004;31:419-30.  Back to cited text no. 3
    
4.
Sheridan T, Herawi M, Epstein JI, Illei PB. The role of P501S and PSA in the diagnosis of metastatic adenocarcinoma of the prostate. Am J Surg Pathol 2007;31:1351-5.  Back to cited text no. 4
    
5.
Esquivel Pinto IA, Torres Alvarez B, Gómez Villa RJ, Castanedo-Cazares JP. A case of prostatic carcinoma manifesting as cutaneous facial nodule. Case Rep Urol 2018;2018:5265909.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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