Cutaneous metastases as initial presentation of malignancy

We describe a case of 73-year-old female who presented with dry cough, chest pain and light-headedness. On examination, multiple subcutaneous masses were noticed on the chest wall, bilateral breast, anterior abdomen and both arms. Subsequent CT-TAP and CT-brain showed multiple subcutaneous nodules in scalp, neck, anterior chest wall, breast and abdomen. A biopsy taken from breast revealed metastatic malignant melanoma; however there was no evidence of primary cutaneous malignant melanoma. We also describe a case of 72-year-old male who presented with tender mass on his lower back and posterior neck. He was known to have COPD and was a heavy smoker. A CT-TAP showed right lower lung mass with soft tissue masses near lumbar spine and lower cervical spine. While awaiting bronchoscopy, biopsy taken from the mass on lower back showed features of metastatic lung adenocarcinoma. In fact, presence of cutaneous metastasis is heraldsign and indicates advanced malignancy with poor prognosis regardless of type of primary malignancy.