Metastasis. A primer for dermatologists

Dermatologists often diagnose, treat, and manage patients who have cutaneous tumors that are potentially metastatic. While the fund of knowledge regarding metastasis is still quite incomplete, more and more is becoming understood about the mechanisms of carcinogenesis and metastasis.

To present in understandable terms what is known about carcinogenesis and metastasis and how this information can and should affect the clinician's approach to diagnosis, management, and follow-up of potentially metastatic cutaneous disease.

The recent literature pertaining to the current understanding of the mechanisms of carcinogenesis and metastasis are assimilated and reviewed.

Carcinogenesis is fundamentally a three-step process comprised of initiation, promotion, and progression. One of the most dramatic results of progression is metastasis. Metastasis is the result of a complex set of cellular adaptations that enable the tumor cell to be able to separate from the primary tumor, invade, intravasate, circulate, implant at a distant site, extravasate, and lastly proliferate.

A fundamental understanding of the mechanism of carcinogenesis and metastasis is important to the clinical dermatologist. Understanding these principles can affect the way in which the practitioner teaches and institutes preventative measures. It may also influence diagnostic and therapeutic approaches as well as subsequent management and follow-up of potentially metastatic or metastatic disease. There is little doubt that the best care for a patient with skin cancer can be given by the physician who knows the most about the integument. This behooves dermatologists to remain well informed about the present understanding of the development and progression of cancer.