Letter to the Editor
Dermoscopy of nodular skin metastases from the gastrointestinal primary cancer

Dermoscopy is a useful, sufficient and widely used tool for examining pigmented and non-pigmented lesions [1, 2]. It may be helpful as a diagnostic method in the investigation of non-characteristic skin nodules, occurring as solitary, pale or pinkish lesions, especially those of unknown origin or in the event of dealing with an unclear patient history. In the literature, there are only several case studies which have been published on the subject of dermoscopic images of metastatic nodules from internal malignancies [3–5]. Skin metastases occur in 0.6–10% of all patients with cancer and represent 2% of all skin tumors [6]. Among gastrointestinal tract malignancies, large intestine cancer among women and cancer of the esophagus, pancreas and stomach cancer among men can often metastasize to the skin [6]. Skin metastases from visceral malignancies are important for dermatologists and oncologists because of their variable clinical appearance and presentation as well as frequent delay or even failure to diagnose them correctly [6]. Metastatic skin nodules occur as non-painful, single or multiple, hard or flexible, tiny, pinkish, small nodules, without any specific clinical diagnostic criteria [4]. Clinical diagnosis in such cases is not clear. From a histopathologic point of view, there are 4 main morphological patterns of cutaneous metastases involving the dermis, namely a nodular, diffuse, infiltrative and intravascular pattern [6]. In dermoscopic evaluation of non-pigmented skin nodules, vascular structures have often played a key diagnostic role, also in the diagnostic management of metastatic skin tumors [7, 8].
The authors report two clinically unspecific cases of dermoscopy, with the presence of a metastatic skin cancer derived from the gastrointestinal tract.
Clinical examination with dermoscopy was performed in both of the cases presented below. Dermoscopic images from each lesion were obtained using a lens (Dermoscope Delta 20; Heine, Herrsching, Germany), mounted on a Nikon D 700 camera.
Totally excised skin nodules were examined histopathologically with the use of a routine histopathological technique in hematoxylin-eosin staining (H + E). Histopathological specimens were sequentially examined field-by-field along the whole section length of the slide. This technique enables us to compare histopathological and dermoscopic pictures.
This is the case of a 60-year-old woman diagnosed with stage IV pT3N1M1 sigmoid colon...


View full text...