History:

Case submitted by Dr Tevor Beer Dermatopathologist Perth.

Punch biopsy, male aged 66.Lesion Left upper lip.

A similar lesion was removed from the forehead at the same time.

Metastatic Malignant Mesothelioma

Whilst advanced mesothelioma is known to occasionally metastasize to the skin, spread to skin away from the chest wall is very rare. In a recent case report¹ the author’s literature review revealed only 6 previous cases.

The histology and immuno findings are characteristic but might not be immediately thought of without a clinical history. In this case the patient was clinically well with no evidence of pain, dyspnoea or any symptoms of malignancy. However, a short while later he developed swelling in the supraclavicular region and in axilla. Imaging studies then revealed a lung mass consistent with mesothelioma.

Interestingly, furthur research revealed that 12 years previously he had a pleural effusion tapped. Cytology on the fluid was reported as being consistent with malignant mesothelioma. He had a history of asbestos exposure. There had been no apparent progression of the mesothelioma over the next 12 years until his presentation with these skin lesions.

Reference:

1. Cassarino DS, Xue W, Shannon KJ. Widespread cutaneous and perioral metastases of mesothelioma. J Cutan Pathol. 2003 Oct;30(9):582-5.