Atypical skin involvement as a harbinger of small-cell lung cancer

A male in his late fifties, a chronic smoker, presented to his primary care physician with multiple painless subcutaneous swellings over the torso, which were misdiagnosed as a cutaneous infection for more than a month. Later, he developed haemoptysis for which he presented to our tertiary care subspecialty unit. Further evaluation with imaging revealed a left lung mass with adrenal and gastric lesions, raising suspicion of a lung malignancy with metastasis. A biopsy from a chest wall swelling confirmed primary lung small cell carcinoma with positive synaptophysin expression. Despite timely whole-brain radiotherapy and chemotherapy, his condition deteriorated rapidly, and he succumbed within weeks. This case highlights the rare presentation of small-cell lung carcinoma with cutaneous metastases, which is associated with poor prognosis.