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Cutaneous Metastases

»	How often do internal malignancies metastasize to the skin?
»	By what three routes do internal malignancies metastasize to the skin?
»	How do malignant cells invade and metastasize?
»	What are the most common cancers that metastasize to the skin in women?
»	What are the most common cancers that metastasize to the skin in men?
»	Do metastases to the skin typically occur in random patterns?
»	Describe the most common presentations of malignancies metastatic to the skin.
»	What is alopecia neoplastica?
»	What is a Sister Mary Joseph’s nodule?
»	Which tumors usually present as a Sister Mary Joseph’s nodule?
»	Does basal cell carcinoma ever metastasize?
»	How do you diagnose a cutaneous metastasis?
»	What is the prognosis of a patient with a cutaneous metastasis?

What is alopecia neoplastica?

Fig. 48.5 Alopecia neoplastica secondary to metastatic breast carcinoma. On palpation, the lesion was firm and indurated.

The scalp appears to be a unique site for cutaneous metastasis, and often cutaneous metastases to the scalp are a presenting sign for internal malignancy. One characteristic clinical presentation is that of an isolated, indurated plaque in the scalp with associated alopecia (Fig. 48-5). Biopsy of this site will demonstrate cutaneous metastasis of a visceral malignancy and loss of hair follicles. The most common tumors to metastasize to the scalp are those of the breast, lung, and kidney.