Gastric adenocarcinoma with recurrence as cutaneous metastatic disease

This is a case of a man in his 60s initially diagnosed with gastric adenocarcinoma and treated with curative intent surgery and chemotherapy 6 years ago. Four years after initial treatment he had locoregional lymph node recurrence treated with curative chemoradiation and was on surveillance with no evidence of disease for 2 years. He presented to clinic with multiple 'bumps' on his head that had been increasing in size for the past 6 months. He has no other associated symptoms aside from 20 pounds of weight loss. The skin nodule was biopsied, and the pathology showed recurrence of his primary gastric adenocarcinoma. A positron emission tomography (PET)-CT showed a small area of metastasis in a single rib alongside this scalp lesion, without any areas of locoregional or intrathoracic recurrence. This is a rare case of cutaneous recurrence of primary gastric cancer without a high burden of intra-abdominal or visceral disease.