Successfully treated carcinoma erysipeloides from gastric cancer

Y. Ikeda*, M. Niimi, H. Kurihara and S. Kodaira

Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

*E-mail: yikeda@med.teikyo-u.ac.jp

In August 2000, a 59-year-old woman underwent a total gastrectomy for a poorly differentiated invasive adenocarcinoma (T2N2M0). After an uneventful postoperative recovery, she was discharged and followed up in the outpatient clinic. She presented with red-purple patches on the left supraclavicular region 2 years after surgery. Profuse granulation tissues extending around the lesions appeared. Skin biopsies showed massive and extensive infiltration of the dermis by clusters of poorly differentiated adenocarcinoma cells. Although the patient received palliative radiotherapy (46 Gy) and intravenous chemotherapy consisting of 5-fluorouracil (5-FU) and mitomycin, the skin lesions rapidly became exacerbated. The extensive lesions had irregular margins lacking clear borders with invasive erythematous plaques and profuse granulation tissues with bleeding, covering the entire left side of the neck extending to the infraclavicular area (Figure 1A).



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Figure 1. (A) Carcinoma erysipeloides, covering the entire left side of the neck extending to the infraclavicular area. (B) Six weeks after chemotherapy, the tumors dried and scab formation is seen.

 
The patient required hospitalization to change the dressings of her left chest tumors and morphine sulfate (50 mg/day) was required to control the severe pain in the left chest wall. The patient received oral administration of 80 mg/day of 1 M tegafur–0.4M 5-chloro-2,4-dihydroxypyridine–1 M potassium oxonate (S-1) for 4 weeks as a final line chemotherapy because of hematological toxicity resulting from the previous chemotherapy. Six weeks later, the lesions dried, diminished remarkably in size and showed scab formation (Figure 1B). The left chest pain disappeared, and the administration of morphine sulfate became unnecessary. She was discharged, and is presently enjoying a normal life.

Metastasis to the skin is a comparatively rare complication of internal malignancies [1]. The clinical presentations appear as flesh-colored to red-purple or brownish solitary papules or nodules. Although carcinoma erysipeloides are frequently observed in patients affected by breast carcinoma, they are rarely observed during the course of other malignant tumors. These metastases are the clinical representation of the rapid spread of tumor cells along subepidermal lymphatic vessels. As a consequence of lymphatic blockage, edema, erythema and vesicles can appear [2]. Although both the appearance of tumors from gastric cancer and their successful treatment are very rare, S-1 was an effective anticancer drug in the present case.

S-1 is a newly developed oral anticancer drug, which consists of tegafur, gimeracil and oteracil potassium at a molecular ratio of 1:0.4:1, based on the biochemical modulation of 5-FU [3]. S-1 was more effective for lymph node metastasis than for the primary lesion, lung metastasis or liver metastasis in a phase II study [4]. Moreover, this oral anticancer drug has the advantage of not requiring hospitalization for patients with good performance status, because of its mild toxicity. The prognosis of gastric cancer with skin metastasis is generally poor, thus treatment preserving the quality of life of cancer patients should be considered positively.

Acknowledgements

The authors are indebted to Professor J. Patrick Barron of the International Medical Communications Center of Tokyo Medical University for his review of this manuscript.

Y. Ikeda*, M. Niimi, H. Kurihara & S. Kodaira

Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan (*E-mail: yikeda@med.teikyo-u.ac.jp)

References

1. 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: 19–26.[ISI][Medline]

2. Lever LR, Holt PJA. Carcinoma erysipeloides. Br J Dermatol 1991; 124: 279–282.[ISI][Medline]

3. Shirasaka T, Nakano K, Takechi T et al. A antitumor activity of 1M tegafur–0.4M 5-chloro-2,4-dihydroxypyridine–1M potassium oxonate (S-1) against human colon carcinoma orthotopically implanted into nude rats. Cancer Res 1996; 56: 2602–2606.[Abstract]

4. Sakata Y, Ohtsu A, Horikoshi N et al. Late phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1M tegafur–0.4M gimestat–1M otastat potassium) in advanced gastric cancer patients. Eur J Cancer 1998; 34: 715–720.





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