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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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)
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