Abstract
75-year-old Caucasian female with a history of HTN, CAD, GERD, DM and pancreatic adenocarcinoma presented to dermatology for evaluation of a one-week history of painful lesions on the neck, chest, and scalp. Physical exam revealed pink, well-circumscribed smooth papules on the chest, neck and frontal hairline with overlying scale with no evidence of ulceration, purulent or serosanguinous drainage. Shave biopsies of the chest and frontal hairline were performed to rule out metastatic pancreatic cancer versus non-melanoma skin cancer or amelanotic melanoma. Histologic examination revealed a glandular infiltrative neoplasm that was strongly positive for CK7 and negative for CDX2 and CK20 (rare positive cells), consistent with a diagnosis of adenocarcinoma of pancreatobiliary origin. This case provided an opportunity for interdisciplinary care - the patient's oncologist was contacted given the rapid progression of cutaneous metastases, as this may signal poor response to current chemotherapy regimen (gemcitabine/abraxane). Unfortunately, the patient continued to decline and decided to pursue hospice care 3 weeks after dermatology visit and passed away several weeks later. The most common sites of metastasis from pancreatic cancer are the liver, peritoneum, lung, bones, and brain. Cutaneous metastases are exceedingly rare approximately 63 cases have been reported in the literature. The most common site of cutaneous metastasis is around the umbilicus and is known as the Sister Mary Josephs nodule. Survival time of 42 patients with cutaneous metastasis of pancreatic cancer ranged from several days to 19 months with median survival time of 5 months.
Financial Disclosure:
No current or relevant financial relationships exist.
