Skin and maxillary sinus involvement of colon cancer

Cutaneous and maxillary sinus metastases of malignancies are not frequent. The most common malignancies metastasizing to the skin in females are breast cancer (69%), colorectal cancer (9%), malignant melanoma (5%) and ovarian cancer (4%). However, lung cancer (24%) followed by colorectal cancer (19%), malignant melanoma (13%) and cancer of the oral cavity (12%) are the common sites in males [1, 2]. Herein, we present a colon cancer patient with maxillary sinus and skin involvement, which are rarely seen localizations of colon cancer metastasis.

A 62-year-old male patient underwent a surgical operation of right hemicolectomy and was diagnosed with stage III colon adenocarcinoma (pT3N1M0) in May, 2006. The pathology was compatible with moderately differentiated adenocarcinoma (Fig. 1) with clear surgical margins but with vascular and neural invasion. Computed tomography (CT) of the thorax and abdomen revealed no metastatic lesions and he received adjuvant oxaliplatin-5FU based chemotherapy for 12 cycles (Nordic-FLOX regimen; oxaliplatin 85 mg/m² day 1, 5FU 500 mg/m² and calcium folinate 60 mg/m² day 1 and 2 in each 14-day cycle). However, he locally relapsed in September 2011 and underwent surgery for the second time due to intestinal obstruction. Local recurrence at the anastomosis was observed and it was surgically resected with negative surgical margins. Postoperative CT scan revealed multiple lung metastases; thus, a combination chemotherapy of CapeOX-bevacizumab (capecitabine: 2000 mg/m² for 14 days, oxaliplatin 130 mg/m² day 1 and bevacizumab 7.5 mg/kg day 1 in each 21-day cycle) was started in November, 2011. After three cycles, newly appearing skin metastases with nodular pattern were observed on lips, and the skin of the nape and face with a swelling on the maxillary region of the face (Fig. 2A, B). Serum CEA and CA19-9 level at that time were in normal ranges. Magnetic resonance imaging (MRI) of the maxillary sinus demonstrated a 36 mm × 46 mm × 43 mm-sized infiltrative mass on the anterior wall of the maxillary sinus with orbital invasion (Fig. 3A). The biopsy taken from one of the skin lesions was compatible with metastasis of adenocarcinoma of colon origin (Fig. 3B). Immunohistochemical staining was positive for CK20 (cytokeratin 20) and negative for CK7 (cytokeratin 7) (Fig. 4). Together with skin metastases, also CTscan revealed radiological progression in lung metastases....


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