Unusual relationship between skin lesions and esophageal cancer: a case report and review of literature

Esophageal cancer is a rare disease. In Spain, this tumor is the third most common gastrointestinal malignancy after colorectal and gastric cancer. Esophageal adenocarcinoma metastasizes to the skin with an incidence of 1 %, generally located in the neck, head and abdomen. It usually occurs in the overlying skin of the primary tumor, but may also appear in a distant site, the scalp being the most common place. Although the pathogenesis of esophageal adenocarcinoma is not well known, the existence of genetic alterations, such as the suppressor gene, has been proved and the involvement of oncogene c-erbB-2 amplified. Cytokeratin 20 and 7 are expressed in esophageal adenocarcinoma. Typically, cutaneous metastases from internal malignancy present as firm asymptomatic nodules. These nodules usually occur in multiple arrays on the skin adjacent to the primary tumor; however, they can occasionally become painful spontaneously. The main diagnostic test of esophageal cancer is the upper endoscopy, along with histopathology for confirmation of the tumor. The developments in surgery and the discovery of new cytotoxic agents have considerably decreased the locoregional recurrence. To date, the combination of these treatment modalities for advanced adenocarcinoma revealed that the recurrences mainly occur from hematic spread. Excision of the skin lesions produces pain palliation. In patients diagnosed with esophageal cancer who have responded satisfactorily to treatment with chemotherapy, radiation and surgery while having a long history of remission, and dermatology outpatient visits by the appearance of skin lesions, should make us think among the different differential diagnoses, the possibility of cutaneous metastases.