Cutaneous metastases from hepatomas

Three cases of hepatomas metastasized to the skin in a series of 88 patients with hepatomas. The skin metastases differed from the usual dermal nodules, such as fibromas, inflammatory granulomas, and adnexal tumors, by their rather sudden appearance as solitary or multiple, nonulcerative, painless, firm, reddish-blue nodules on the scalp, chest, and shoulder. Biopsies of these nodules were necessary in order to confirm the diagnosis of the cutaneous metastases, which appeared before the primary tumors were recognized. Microscopically, the skin tumors were adenocarcinomas in two instances and hepatocellular carcinoma in one. The skin metastases were a late manifestation of the primary tumors; the patients died within three weeks to six months after the appearance of skin tumors. Necropsies showed widespread metastases.