Non-hematopoietic cutaneous metastases in children and adolescents: thirtyyears experience at St. Jude Children's Research Hospital

Background: The spectrum of cutaneous metastasis of non-hematopoietic neopl asms in the pediatric population is not well documented. We report the hist ologic diversity of this unusual process over a 30-year period at a tertiar y care center for pediatric malignancy (St. Jude Children's Research Hospit al, Memphis, TN, USA). Methods: Of 1,971 pathology accessions which included histologic material o n skin (1,604 surgical cases and 367 autopsy cases) we found 40 cases (2% o f total skin accessions) coded for metastatic nonhematopoietic malignancy. Results: The patients (n=34) ranged in age from 1 month to 20 years (mean=9 .8 years) and had a male:female ratio of 1:1. The histologic diagnoses were as follows: rhabdomyosarcoma NOS (6 cases), embryonal rhabdomyosarcoma (4 cases), alveolar rhabdomyosarcoma (4 cases), neuroblastoma (8 cases), osteo sarcoma (2 cases), choriocarcinoma (2 cases), peripheral neuroepithelioma o r Ewing's sarcoma (2 cases), malignant rhabdoid tumor (1 case), paraganglio ma (1 case), nasopharyngeal carcinoma (1 case), sarcoma NOS (1 case), colon adenocarcinoma (1 case), and malignant melanoma (1 case). Conclusions: Cutaneous or subcutaneous metastasis of non-hematopoietic mali gnancies in children and adolescents is a rare occurrence but in a high per centage of cases may be the first manifestation of disease. The tumors most likely to metastasize to the skin in children are rhabdomyosarcoma and neu roblastoma and they are more likely than adult malignancies to disseminate to multiple distant sites. (C) Munksgaard 2000.