Abstract:

The rate of metastasis to the skin occurs in less than 10% of malignancies and is rarely the first manifestation of malignancy. Cutaneous metastases are more common in elderly patients with high stage neoplasms and are usually indicative of a poor prognosis. Furthermore, ovarian neoplasms rarely metastasize to the skin with an incidence of 2-5% and a proclivity for the abdominal skin, most notably at the umbilicus. We present a case report of a 67-year-old female who initially presented with ascites remarkable for malignant cells of Mullerian origin. The patient underwent multiple pelvic and abdominal surgeries for a FIGO IIIc high grade serous ovarian/fallopian tube carcinoma. Despite completing a rigorous chemotherapy regimen, a new PET scan found a suspicious left inguinal lymph node. Additionally, on physical exam, the patient had a 3 x 8 cm erythematous nodular plaque with scattered ulcerations surrounding a fistula tract on the left upper abdomen. Histopathologic examination of a punch biopsy showed a superficial and deep infiltration of single cells and nodular aggregates in the dermis. The cells were highly pleomorphic with bizarre nuclei, prominent nucleoli, and smudged chromatin. Immunohistochemical staining confirmed metastatic serous carcinoma. Nonumbilical ovarian cutaneous metastasis, as seen here, are less common and indicative of advanced cancer. The incidence is higher in older patients and those who did not receive platinum or taxane chemotherapy regimens. The mechanisms of metastasis include contiguous spread, implantation, and lympho-hematogenous spread. Nonumbilical tumors are often observed at sites of previous incisions, suggesting surgical contamination is a common cause.

Financial Disclosure:
No current or relevant financial relationships exist.

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Jesse Fitzgerald, DO