Skin Metastases As First Manifestations of Adenocarcinoma of the Lung: A Case Report

Lung cancer is the second most common malignancy worldwide, accounting for the highest number of cancer deaths. Advanced lung cancer may infrequently appear as skin metastasis and this may be the first sign of the disease. In these cases, survival is low and prognosis is poor. The aim of this study is to report a case of adenocarcinoma of the lung where the earliest manifestations were skin metastases to the face, cervical region, and chest. A 67-year-old male, former smoker, and alcoholic was referred to the oncology center for investigation of a primary tumor site, presenting with skin lesions suggestive of metastasis to the face, cervical region, and chest. Computed tomography (CT) scan of the chest, cholangioresonance, breast ultrasonography, colonoscopy, upper GI endoscopy, and magnetic resonance imaging of the brain were performed. Imaging studies revealed disseminated cancer with a potential primary site in the right lung. Positron emission tomography (PET)-CT scan demonstrated secondary implants and was consistent with primary right lung cancer. The patient underwent a right lung biopsy of the skin and breast and axillary lymph nodes. A solid subtype of adenocarcinoma with metastases to the skin and axillary nodes was confirmed. Due to widespread metastatic disease, the case was conducted using strategies including chemotherapy and palliative radiotherapy for symptomatic control. At about 6 months of follow-up care, the patient died. In the elderly, periodical cancer screening is important, especially in patients with major risk factors (e.g., history of smoking). Some cancers may be virtually silent and manifest themselves only at advanced stages beyond treatment possibilities.