Multiple cutaneous metastases as the first sign of lung cancer in a patient with well-differentiated papillary transitional cell carcinoma of the urinary bladder

A case of multiple, cutaneous metastases as the first sign of lung cancer i n a patient with well-differentiated, papillary, transitional cell carcinom a of the urinary bladder is presented. In the left clavicular region were t wo, sharply demarcated, dark red tumors measuring 3 and 2 cm in diameter wi th a history of rapid growth and intermittent spontaneous bleeding. Thoroug h examination of the patient revealed 16 additional skin lesions, which wer e dark red macules and papules, 2-3 mm in diameter, situated on the left si de of the chest. The skin biopsy material (tumors, macular and papular lesi ons) was studied using histological and immunohistochemical techniques and showed intact epidermis and massive dermal and subcutaneous metastatic invo lvement by a small cell carcinoma with neuroendocrine differentiation most likely originating in the lung.