The Evaluation of Cutaneous Metastasis from an Unknown Primary.

We present the case of a man that had a rapidly growing nodule on his face. Removal of the lesion was more difficult than anticipated because it was tightly adherent to adjacent tissue. Pathology from the lesion showed a malignant neoplasm thought to have arisen at a distant site. The evaluation of this patient may provide insights into the workup for patients that present with cutaneous metastatic malignancies of unknown etiology. In general, these patients need to be fully evaluated in an attempt to locate the primary lesion. When a primary lesion can not be ascertained, careful surveillance of the patient is warranted. We present suggestions for evaluation of patients with cutaneous metastatic lesions without an obvious primary. It is clear that molecular pathology will provide additional information to help identify the primary lesion. Scanning of areas likely to be the source using CT PET/ CT and MRI studies may also yield information. Finally, a careful history and physical examination are also important for these patients. J Drugs Dermatol. 2018;17(7):804-806.