Multiple cutaneous metastases as the first sign of metastatic carcinoma of unknown primary

Description

An elderly man with a background of bladder cancer in remission, monoclonal gammopathy of uncertain significance and chronic obstructive pulmonary disease was referred by his general practitioner to the dermatology clinic with enlarging, non-tender cutaneous nodules on his neck, upper back and scalp. The first of these had been noted above the left clavicle 3 months previously during a hospital admission, and had since rapidly increased in size, together with a more recent development of newer 'bumps' on the scalp.

On physical examination there was a 25x20 mm cutaneous nodule sited above his left clavicle (figure 1A). This nodule was firm but not hard, oval-shaped, mobile, had prominent visible vasculature and no associated surface epidermal change. In addition, there were three similar lesions sited adjacent to each other on the vertex of his scalp, and one macular lesion on his upper back (figure 1B). The diagnosis of...

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