BMJ Case Reports 2018; doi:10.1136/bcr-2017-223970
  • Images in…

Multiple cutaneous metastases as the first sign of metastatic carcinoma of unknown primary

  1. Pamela Todd
  1. Dermatology, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to Dr Sonia Rupal Sharma, soniarupal.sharma{at}, sonia.sharma{at}
  • Accepted 6 February 2018
  • Published 9 March 2018


An elderly man with a background of bladder cancer in remission, monoclonal gammopathy of uncertain significance and chronic obstructive pulmonary disease was referred by his general practitioner to the dermatology clinic with enlarging, non-tender cutaneous nodules on his neck, upper back and scalp. The first of these had been noted above the left clavicle 3 months previously during a hospital admission, and had since rapidly increased in size, together with a more recent development of newer ‘bumps’ on the scalp.

On physical examination there was a 25×20 mm cutaneous nodule sited above his left clavicle (figure 1A). This nodule was firm but not hard, oval-shaped, mobile, had prominent visible vasculature and no associated surface epidermal change. In addition, there were three similar lesions sited adjacent to each other on the vertex of his scalp, and one macular lesion on his upper back (figure 1B). The diagnosis of multiple cutaneous metastases was suspected, with the differential diagnoses including cutaneous lymphoma. Rapid access imaging and 4 mm cutaneous punch biopsy were performed.

Figure 1

Scalp and neck nodules.

CT of the head, neck, chest, abdomen and pelvis without contrast, due to iodine allergy, demonstrated a cavitating left upper lobe lung lesion and probable brain metastases, but no …

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