Two independent incidences of skin metastases in the umbilicus and abdominal wall in ovarian serous adenocarcinoma: A case report and review of the literature

RATIONALE: Advanced ovarian cancer is usually associated with intra-abdominal metastases and while it commonly spreads directly to the omentum, intestine, liver, or other organs, it can also metastasize through the lymphatic channels and the hematogenous pathway. With an increasing number of invasive operations being performed with chemoradiotherapy, the incidence of extra-abdominal metastases has risen. Nevertheless, ovarian cancer with skin metastases is quite rare. PATIENT CONCERNS: We report a case of ovarian cancer with two independent incidences of skin metastases in the umbilicus and abdominal wall. DIAGNOSES: The patient was a 67-year-old woman who was diagnosed with ovarian cancer stage IIIC and underwent cytoreductive surgery. A solitary brown cauliflower-like metastatic lesion, approximately 6 × 5 × 4 cm was identified in the umbilicus area two years after primary surgery. During tumorectomy, intraoperative exploration revealed that while the tumor was located close to the peritoneum, there was no penetration. INTERVENTIONS: The patient recovered well and received multiple rounds of chemotherapy. Ten months later, the patient presented with skin lesions located on the abdominal wall that grew rapidly and spread from the lower abdomen wall to the bilateral waist and femoral skin. These lesions were multiple, ulcerated, rough heliotrope plaques that produced a foul-smelling faint yellow liquid. Biopsy analysis revealed skin metastasis of poorly differentiated serous adenocarcinoma. OUTCOMES: The patient was treated with chemotherapy but died 3 months after the skin metastasis occurred for the second time. LESSONS: Ovarian cancer with skin metastasis is a rare condition with poor prognosis. Pathological diagnosis of early skin lesions is essential for ovarian cancer patients and that systemic and local disease should be treated with surgery or palliative therapy in order to provide patients with the best chances of survival. Tumorectomy is appropriate when lesions are isolated and when the patient's performance status is good. However, systemic therapy including chemotherapy and radiotherapy should be considered when skin lesions are associated with severe intro-abdominal disease.