Ulcération cutanée: penser aux métastases

We report the case of a 68-year old patient, with a history of chronic smoking, presenting with cutaneous swelling at the level of the anterior chest wall evolving over a period of 5 months and gradually increasing in size. It was associated with gradually worsening exertional dyspnoea evolving in a context of an alteration of general state and 15kg weight loss. Mucocutaneous examination objectified rounded, well-defined cutaneous swelling measuring 5cm x 5cm, with erythematous border and with ulcerated surface (A). Lymph nodes examination showed two painless, mobile, bilateral axillary adenopathies with a firm consistency, each measuring 2cm. Histological and immuno-histochemical examination of skin biopsy specimen showed adenocarcinoma compatible with a lung origin (B and C). Chest CT scan confirmed the presence of left lingular pulmonary process (D). The therapeutic approach was based on pemetrexed + platinum salt chemotherapy. The patient died 4 months after the diagnosis of the disease.