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Abstract

Background: Cutaneous metastases were reported in 18.6-26.5% of breast cancer patients. Zosteriform cutaneous metastasis is an unusual and rare morphological variant. Clinicians, especially dermatovenereologists, should consider dermatomal cutaneous metastases in oncology patients aside from herpes zoster, which is common in this population.

Case Illustration: A 62-year-old woman presented with clustered papules and vesicles with an erythematous base, sometimes painful, on the right side of the chest in T5-T7 dermatomal distribution of 1-month duration. She had undergone a radical mastectomy for breast carcinoma and had been receiving chemoradiotherapy, which was completed in March 2018. A diagnosis of zosteriform cutaneous metastases was established after discovering malignant cells in the representative lesion via biopsy, similar to those sampled from the previous cancerous right mammary tissue.

Discussion: Zosteriform cutaneous metastasis is a rare occurrence, with a variety of clinical backgrounds, morphological, and histological features that can influence the clinical course of the disease. The mechanism for the occurrence of zosteriform cutaneous metastasis remains uncertain; several studies reported possible causes: Koebner-like reactions at the site of previous herpes zoster infections, perineural lymphatic spread, spread through blood vessels associated with the dorsal ganglion, unintentional implantation during surgery, direct invasion of the underlying structure (primary cancer), and spread from the lymphatic system. This case suits the diagnosis of zosteriform cutaneous metastases based on lesion morphology, location, distribution, and histopathological features matching those of the primary tumor.

Conclusion: Metastatic disease should be considered in the differential diagnosis of zosteriform rash in oncology patients.

References

  1. Virmani NC, Sharma YK, Deo KS. Zosteriform skin metastases: Clue to an underdiagnosed breast cancer. Indian J Dermatol. 2011;56(6):726-7.
  2. Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: A clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol. 2004;31(6):419-30.
  3. LeSueur BW, Abraham RJ, DiCaudo DJ, O'Connor WJ. Zosteriform cutaneous metastases. Int J Dermatol. 2004;43(2):126-8.
  4. Rao R, Balachandran C, Rao L. Zosteriform cutaneous metastases: A case report and brief review of literature. Indian J Dermatol Venereol Leprol. 2010;76(4):447.
  5. Hu SC, Chen GS, Wu CS, Chai CY, Chen WT, Lan CC. Rates of cutaneous metastases from different internal malignancies: Experience from a Taiwanese medical center. J Am Acad Dermatol. 2009;60(3):379-87.
  6. Sariya D, Ruth K, Adams-McDonnell R, et al. Clinicopathologic correlation of cutaneous metastases: Experience from a cancer center. Arch Dermatol. 2007;143(5):613-20.
  7. Savoia P, Fava P, Deboli T, et al. Zosteriform cutaneous metastases: A literature meta-analysis and a clinical report of three melanoma cases. Dermatol Surg. 2009;35(9):1355-63.
  8. Juanes JS, Escobar ML, Palicio NV, et al. Zosteriform cutaneous metastases from a breast carcinoma. Med Cutan Iber Lat Am. 2007;35(2):89-93.
  9. Bauza ́ A, Redondo P, Idoate MA. Cutaneous zosteriform squamous cell carcinoma metastasis arising in an immunocompetent patient. Clin Exp Dermatol. 2002;27(3):199-201.
  10. Bassioukas K, Nakuci M, Dimou S, et al. Zosteriform cutaneous metastases from breast adenocarcinoma. J Eur Acad Dermatol Venereol. 2005;19(5):593-6.
  11. Kamisawa T, Takahashi M, Nakajima H, Egawa N. Gastrointestinal: Zosteriform metastases to the skin. J Gastroenterol Hepatol. 2006;2(3):620.
  12. Kondras K, Zalewska A, Janowski P, Kordek R. Cutaneous multifocal melanoma metastases clinically resembling herpes zoster. J Eur Acad Dermatol Venereol. 2006;20(4):470-2.
  13. Brassanac D, Boricic I, Todorovic V. Epidermotropic metastases from breast carcinoma showing different clinical and histopathological features on the trunk and on the scalp in a single patient. J Cutan Pathol. 2003;30(10):641-6.
  14. Manteaux A, Cohen PR, Rapini RP. Zosteriform and epidermotropic metastasis. Report of two cases. J Dermatol Surg Oncol. 1992;18(2):97-100.

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