2008 Feb 8;259(2):177-85. doi: 10.1016/j.canlet.2007.10.013. If confirmed in future studies, this information could potentially be used to guide treatment decisions, she said. We identified a total of 26 patients with 49 resected skin metastases. Lung Cancer Symptoms Appearing on the Skin Yellow Skin. Dequanter D, Mboti FB, Lothaire P, Andry G. Kotsinas A, Evangelou K, Sideridou M, Kotzamanis G, Constantinides C, Zavras AI, Douglass CW, Papavassiliou AG, Gorgoulis VG. If you or a family member or friend have recently been diagnosed with melanoma, you may be wondering, just where and why can melanoma spread? Symptoms of Horner syndrome affect just one side of the face and include: Superior vena cava syndrome can be caused by lung cancers in the upper right lung and lymph nodes inside the chest. Your doctor will ask about symptoms and check you for signs of the cancer coming back or a new skin cancer. The reason for this is unknown. 2022 Oct;23(5):237-240. doi: 10.7181/acfs.2022.00892. The biggest task, she said, will be to follow patients with earlier-stage colorectal cancer and investigate whether these specific combinations of mutations are indeed predictive of disease progression. In very rare cases, skin metastasis may occur at the same time or before the primary cancer has been discovered and may be the prompt for the further thorough investigation. Cutaneous metastasis may also occur from skin cancer, usually melanoma. J Med Case Rep. 2015 Oct 7;9:231. doi: 10.1186/s13256-015-0707-4. 2 Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. After putting together clinical findings, special studies on tissues , and with microscope findings, the pathologist arrives at a definitive diagnosis. Recommended Reading: Does Amelanotic Melanoma Blanch When Pressed. Intern Med. Chest X-ray and computed tomography revealed an expansive process in the 7(th) segment of the left lung, left hilar and mediastinal lymphadenopathy and a suspicious initial secondary deposit in the left adrenal gland. The .gov means its official. 2022 Sep 12;15:1869-1872. doi: 10.2147/CCID.S381327. Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Ann Dermatol Venereol. Abstract We reviewed our 10-year experience in skin metastases from lung cancer. All histological types of lung cancer may metastasize to the skin and clinical lesions are variable. Federal government websites often end in .gov or .mil. Your skin, along with your hair, nails, oil glands and sweat glands, is part of the integumentary (in-TEG-you-ME I NT-a-ree) system. Ectopic Cushing syndrome in small cell lung cancer: A case report and literature review. Disclaimer, National Library of Medicine This site needs JavaScript to work properly. Dermatol Clin. A study published in March 2017 in the Journal of Cancer Research and Clinical Oncology focused on patients with stage 4 metastatic melanoma and found that new drugs available since 2011 were, in fact, extending lives. A lung cancer metastasis is usually classified only as adenocarcinoma, squamous cell carcinoma (SCC), or undifferentiated carcinoma. An unusual skin nodule. A paradigm shift has taken place over the past 2 decades with regard to perceptions around testosterone therapy as a treatment for metastatic prostate cancer, potentially opening the door for a novel strategy for the population, according to Mohit Khera, MD, MBA, MPH; however, he emphasized that confirmatory phase 3 research is necessary to push The site is secure. Recommended Reading: Soderstrom Skin Cancer Screening. We clinically reviewed 16 cases of skin metastasis. These all affect the persons outlook. doi:10.1080/2162402x.2016.1231292. This causes flushing and a lack of sweating on one half of the face only. 2012 Jun;34(4):347-93. doi: 10.1097/DAD.0b013e31823069cf. Some patients find the steps below helpful. St. Louis: Mosby; 2006. pp. 2014;5(3):197-223. doi:10.5306/wjco.v5.i3.197, Ng T, Damiris K, Trivedi U, George J.Obstructive jaundice, a rare presentation of lung cancer: A case report. If the liver is affected, it can cause a buildup of bile salts that leads to itching. sharing sensitive information, make sure youre on a federal -, Oncol Rep. 2001 Jan-Feb;8(1):57-61 J Bras Pneumol. Pulmonary large-cell neuroendocrine carcinoma presenting as multiple cutaneous metastases. In women, about 70% of cutaneous metastases originate from the breast. Before The patient was referred to the department of oncology for further treatment. Cutaneous metastasis from lung cancer is rare, but physicians should understand its significance. official website and that any information you provide is encrypted government site. The relative frequency of skin metastasis correlates with the type of primary cancer, which occurs in each sex. Metastases to the nail unit and distal phalanx: a systematic review. Atallah-Yunes SA, Clark J, Samanani S, Soe M. Am J Case Rep. 2019 Feb 17;20:207-211. doi: 10.12659/AJCR.913388. Examples of some of these types of drugs and the side effects they have on the skin include: The skin can be affected by lung cancer that has spread, different syndromes associated with lung cancer, and treatments for lung cancer. Unable to load your collection due to an error, Unable to load your delegates due to an error. Poor prognostic indicators include non-resectable or small-cell primary tumors, multiple cutaneous metastases, or other distant metastases. BMJ Case Rep. 2020 Nov 23;13(11):e235938. 2007 May;143(5):613-20. doi: 10.1001/archderm.143.5.613. Rana V, Kulhari K, Dabbas D, Murthy HS, Takkar P. Indian J Dermatol. Careers. Federal government websites often end in .gov or .mil. MeSH Arch Craniofac Surg. 2022 Dec 5;8(12):e12080. Over the past 2 months, the patient lost 20 pounds and noticed "bumps" on her body. This mole may be asymmetrical, have an uneven border, have an inconsistent color, be large or change over time. Distant metastases at the time of non-small-cell lung cancer (NSCLC) presentation are a frequent clinical problem. The research on cancer metastasis is rapidly growing. Bethesda, MD 20894, Web Policies eCollection 2022 Jul. 1972 Dec;135(6):961-75. Online ahead of print. Skin symptoms can be caused by a variety of conditions ranging from eczema to cancer. The value of immunohistochemical expression of TTF-1, CK7 and CK20 in the diagnosis of primary and secondary lung carcinomas. eCollection 2022 Sep-Dec. Zhong L, Mao D, Li H, Chen X, Jin J, Wen G. Clin Cosmet Investig Dermatol. It's always better to see your doctor to rule out orconfirm a diagnosis, as lung cancer can often go undetected until the later stages, when treatments are less effective. The pathogenesis of cutaneous metastases from lung cancer is suggested to be by lymphovascular invasion, with poor differentiation and upper lobe tumors increasing the risk. Cutaneous metastasis as a initial presentation in advanced non-small cell lung cancer and its poor survival prognosis. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. Disclaimer, National Library of Medicine Clinical features of skin metastasis from lung cancer Metastasis to the skin from lung cancer is less common than metastasis to other organs. We clinically reviewed 16 cases of skin metastasis. Lung Tumor Skin Metastasis: Case Report of a Solitary Cutaneous Ulcerated Lesion as Initial Manifestation of Lung Carcinoma. Would you like email updates of new search results? During an examination for suspected melanoma, your doctor will check nearby skin and lymph nodes for signs that cancer has spread. doi: 10.7759/cureus.27285. Bookshelf doi: 10.1016/j.det.2007.08.004. The nodules measuring 5-15 millimeters in greatest dimension were round and skin-colored, with telangiectasias, firm and tender. Skin metastases were synchronous in 6 patients, 3 of whom underwent primary simultaneous resection, and solitary in 6 (6/26=23.07%). Clipboard, Search History, and several other advanced features are temporarily unavailable. eCollection 2022 Sep-Dec. Kim HK, Kang SH, Kim WS, Kang SH, Kim WJ, Kim HS, Bae TH. Careers. Cutaneous Metastasis of Lung Adenocarcinoma: Initially Mimicking and Misdiagnosed as Keloids. 9 Between 7-24% of these patients have cutaneous lesions as an initial sign of malignancy. 2011 Jun;25(6):722-6. doi: 10.1111/j.1468-3083.2010.03818.x. Federal government websites often end in .gov or .mil. Treatment Of Lung Metastases Treatment for lung metastases is usually based on the main type of cancer the person has. This site needs JavaScript to work properly. You May Like: What Is The Most Aggressive Skin Cancer. Rolz Cruz G, Kim CC. The rate at which lung cancer spreads depends on various factors, including the type of cancer and the persons overall health. Lung cancer that has spread to another organ or has caused a syndrome, such as the following, may lead to symptoms that appear on the skin. Squamous cell carcinoma of the lung presenting as a fungating ulcerated skin lesion: a case report. eCollection 2022 Jul. What you can change is how you live the rest of your life making healthy choices and feeling as good as you can. official website and that any information you provide is encrypted and transmitted securely. government site. 2021 Sep-Oct;66(5):576. doi: 10.4103/ijd.ijd_18_21. 2017;111(3):195-195. doi:10.1093/qjmed/hcx207. Grzywa-Celiska A, Szmygin-Milanowska K, Emeryk-Maksymiuk J, Celiski R, Sobieszek G, Siwiec J, Krusiski A, Milanowski J. Postepy Dermatol Alergol. Basal and squamous skin cancer may look like: Healthy Skin World is one-stop resource for everything you need to know about skin cancer. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Three-year survival for patients who entered stage 4 in 2013 and 2014 was 37 percent, compared with in March 2017 those who entered stage 4 in 2011 and 2012 . This is how doctors can tell that it is cancer that has spread from another part of the body. 1,2 The most common sites of metastases from lung cancer are the liver, bones, brain, adrenal glands, lymph nodes, and, rarely, skin. 8600 Rockville Pike 2020 Dec 4;99(49):e23281. Three cases with non-small cell lung cancer (NSCLC) with skin involvement and rapidly fatal clinical course due to extensive CNS metastasis are reported. Accessibility Cancer Research UK. Unfortunately, if the lesion recurs , gets thicker, or spreads from the skin to the lymph nodes or distant organs, it becomes much more dangerous. The .gov means its official. You may be surprised to learn that lung metastases are quite common. Lung Cancer Symptoms on the Skin to Watch For. Hasan Ali O, Diem S, Markert E et al. Itchy skin can be another sign that lung cancer has spread to the liver. Bethesda, MD 20894, Web Policies Thus, lung cancer with its recognized propensity for spread to brain, bone, liver, and Cutaneous Metastasis from Lung Adenocarcinoma. Scientists suggest that dermatomyositis complicated with non-small cell lung cancer is not rare and severe lung cancer could develop rapidly. The findings FOIA In metastasis, cancer cells break away from where they first formed , travel through the blood or lymph system, and form new tumors in other parts of the body. Ciliberti MP, Carbonara R, Grillo A, Leo AM, Lolli I, Ostuni C, Troiani L, Turi B, Vallarelli S, Sardaro A. BMC Cancer. Vernemmen AIP, Li X, Roemen GMJM, Speel EM, Kubat B, Hausen AZ, Winnepenninckx VJL, Samarska IV. Negative prognostic factors were primary non-resectability (p=0.001), small cell lung cancer (p=0.032), simultaneous discovery of other cutaneous (p=0.048) or extracutaneous (p=0.0005, Wald test p<0.002, Odds ratio =14.37) metastases. The percentage of patients with lung cancer who develop skin metastasis ranges from 1-12%. Marcoval J, Penn RM, Llatjs R, Martnez-Ballarn I. Australas J Dermatol. Goljan EF. Federal government websites often end in .gov or .mil. NCI CPTC Antibody Characterization Program. Skin metastasis represented the unique distant localization in almost one quarter of our cases that represent the best-survivor category: in these patients skin metastasectomy is justified. government site. 2022 Jul 26;14(7):e27285. Sariya D, Ruth K, Adams-McDonnell R, Cusack C, Xu X, Elenitsas R, Seykora J, Pasha T, Zhang P, Baldassano M, Lessin SR, Wu H. Arch Dermatol. Author: Vanessa Ngan, Staff Writer, 2005. The superior vena cava is a major vein that carries blood from your head, neck, upper chest, and arms to the heart. An unusual case of pulmonary adenocarcinoma with multiple and extraordinary metastases. The .gov means its official. chemotherapy to kill cancer cells and reduce tumor size, hormone therapy to reduce the hormones known to be involved with breast and prostate cancer, surgery if necessary to stabilize your bone, fix a break, and help with pain, physical therapy to strengthen your muscles and help you with mobility, extreme heat or cold that targets cancer cells and may relieve pain, Flat, firm, pale or yellow areas that look a lot like a scar, Rough or scaly red patches, which might crust or bleed, Small, pink or red, shiny, pearly bumps, which might have blue, brown, or black areas, Pink growths or lumps with raised edges and a lower center, Open sores that dont heal, or that heal and then come back. Epub 2018 Feb 12. For many types of cancer, it is also called stage IV cancer. Bethesda, MD 20894, Web Policies official website and that any information you provide is encrypted Characterization of nivolumab-associated skin reactions in patients with metastatic non-small cell lung cancer. It is an emergency so if you have these symptoms, you need to contact your cancer specialist straight away or go to the accident and emergency department. 2008;26:89102. Zhang H, Zhao J.Ectopic Cushing syndrome in small cell lung cancer: A case report and literature review. Cutaneous metastasis from lung cancer: retrospective analysis of 30 patients. Before Long term actuarial survival after cutaneous metastasis was calculated using by the Kaplan-Meier method. Clipboard, Search History, and several other advanced features are temporarily unavailable. Controlling symptoms is important, especially if treatment for the main cancer is not effective or may take a while to help. Falbo F, Krizzuk D, Urciuoli P, Biancucci A, Galiffa G, Donello C, Esposito A, Mongardini FM, Sammartino F. Case Rep Oncol. If you are experiencing symptoms or are concerned you may have lung cancer, make an appointment and get checked out even if you think it might not be anything significant. coughing up blood and mucus. Disclaimer, National Library of Medicine Pathologic findings included adenocarcinoma in 18 patients, large-cell carcinoma in 9, squamous cell carcinoma in 5, and small-cell carcinoma in 2. We clinically reviewed 16 cases of skin metastasis. Bethesda, MD 20894, Web Policies The lung is probably the most common site of primary lesions that metastasize to this region. Surgery may be an option if there are a small number of lung metastases and there are no metastases in other parts of the body. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. 2006 Aug;8(8):616-7. doi: 10.1007/s12094-006-0069-x. The skin is the largest organ of the body, with a total area of about 20 square feet. To get a better handle on the timing of metastasis, the team developed a computer model to simulate the evolution of millions of virtual tumors under different conditions. Cutaneous metastases from the lung are rare but must be ruled out in patients with suspicious skin lesions and history of smoking or lung cancer. 1 In a review of 7316 cancer patients, skin involvement as a presenting sign was seen in only 0.8% of patients. JAAD Case Rep. 2022 Nov 24;31:105-108. doi: 10.1016/j.jdcr.2022.11.016. government site. In 24 men and 10 women, ages ranged from 32 to 85 years (mean, 61 years). We present the case of a 51-year-old male smoker initially given a diagnosis of right lower lung adenocarcinoma T2N3M0 who developed new-onset zosteriform skin metastasis over the right-side T3T5 dermatomes documented by skin Pancoast tumors can lead to Horner syndrome. In 1-12% of patients with lung cancer are developed skin metastases. 2001 Dec;128(12):1310-5. 2022 Oct;23(5):237-240. doi: 10.7181/acfs.2022.00892. The film stars Jamie Bell, Danielle Macdonald, Daniel Henshall, Bill Camp, Louisa Krause, Zoe Colletti, Kylie Rogers, Colbi Gannett, Mike Colter, and Vera Farmiga. Cutaneous (skin) metastasis occurs when cells from a cancer in the body spread to the skin. About 85% of people with the disease have this type. Acute secondary adrenal insufficiency as the presenting manifestation of small-cell lung carcinoma. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. And then, if thats true, we will have a rationale to go forward with clinical studies. For example, if the cancer starts in a mucous membrane rather than on the skin, a mole may not be present. trouble breathing or shortness of breath. Epub 2022 Oct 20. In general, cancers that tend to metastasize to other organs also involve the skin. 2. 2017;9(12):E1110-E1117. Cutaneous metastasis. Occasionally, healthcare providers are unable to determine the primary site of cancer. Cancer researchers are already exploring noninvasive methods that could detect cancer at an early stage by analyzing tumor cells, or pieces of DNA from tumor cells, that have escaped from the original tumor and are found in the blood. sharing sensitive information, make sure youre on a federal Clipboard, Search History, and several other advanced features are temporarily unavailable. In very rare cases, skin metastasis may occur at the same time or before the primary cancer has been discovered and may be the prompt for the further thorough investigation. Cutaneous metastases as initial manifestation of internal neoplasias, represent only 0.8% of total cases and implies, in general, a very advanced grade of the disease and short survival. PMC Skin symptoms can be an unexpected sign of lung cancer. Careers. The https:// ensures that you are connecting to the This approach, often called a liquid biopsy, could help doctors identify patients at risk for metastasis and treat them with chemotherapy or targeted therapies, if available, to try to eliminate metastatic cells that have spread in the body before surgery, Dr. Boudreau said. Thus, lung cancer, which spreads to brain, bone, liver, and adrenal glands, is responsible for the majority of skin metastases in men and is second only to breast cancer as the source of skin metastases in women. The 3' UTR IGF2R-A2/B2 variant is associated with increased tumor growth and advanced stages in non-small cell lung cancer. Skin metastasis from lung cancer is an unusual event carrying an ominous prognosis. Billing PS, Miller DL, Allen MS, Deschamps C, Trastek VF, Pairolero PC. -, Nihon Kyobu Shikkan Gakkai Zasshi. Before doi: 10.1016/j.heliyon.2022.e12080. official website and that any information you provide is encrypted Would you like email updates of new search results? Almost all lesions ranged from 1 to 5 cm in diameter. There was only a slight response to combination chemotherapy carried out 5 cases for lung cancer, and most lesions were progressive. Haghighatkhah HR, Sanei Taheri M, Kharrazi SM, Ghazanfari Amlashi D, Haddadi M, Pourabdollah M. Iran J Radiol. Clipboard, Search History, and several other advanced features are temporarily unavailable. By Helen Massy In general, cancers that often metastasize to other organs also do so to the skin. See the Carcinoma of Unknown Primary page for more information. Cutaneous metastasis from lung cancer is rare. In general, cancers that tend to metastasize to other organs also involve the skin. Thus, lung cancer, which spreads to brain, bone, liver, and adrenal glands, is responsible for the majority of skin metastases in men and is second only to breast cancer as the source of skin metastases in women. FOIA -, J Am Acad Dermatol. The eventual association of skin metastases and a phenotype with "CNS-predilection" or an aggressive phase of NSCLC are discussed. Shiono S, Ishii G, Nagai K, Yoshida J, Nishimura M, Murata Y, Tsuta K, Nishiwaki Y, Kodama T, Ochiai A. Ann Thorac Surg. According to the American Cancer Society, people with non-small cell lung cancer that has spread to distant areas have a 7% chance of surviving another 5 years after their diagnosis. Would you like email updates of new search results? and transmitted securely. Targeted therapies for lung cancer. Skin metastases of lung cancer are rare. Bolewska A, Sowiska M, Boska A, Ceryn J, Grala B, Narbutt J, Ciyska M, Maecki W, Skibiska M, Lesiak A, Paluchowska E, Owczarek W. Clin Cosmet Investig Dermatol. They analyzed publicly available data from 938 people with metastatic colorectal cancer and 1,813 people with early-stage, nonmetastatic colorectal cancer whose medical histories were known. Lymph nodes are clusters of cells that filter a fluid called lymph.2 Lymph carries the white blood cells that help your body fight infection. Disclaimer, National Library of Medicine An official website of the United States government. 2005 Jan;79(1):278-82; discussion 283. doi: 10.1016/j.athoracsur.2004.06.096. The currently available data puts the five-year survival rate for stage 3 cancer at between 40 and 78 percent , and for stage 4 melanoma at 15 to 20 percent. 1, 2 About 1 to 12 Would you like email updates of new search results? The most noticeable sign of melanoma is the appearance of a new mole or a change in an existing mole or birthmark. 49 ): e23281 skin Lesion: a Case report and literature review not and! ( 49 ): skin metastases from lung cancer a fungating Ulcerated skin Lesion: a Case report a... Various factors, including the type of cancer the person has of cutaneous metastases, make sure youre a! Bile salts that leads to itching K, Dabbas D, Murthy HS, Takkar Indian. Igf2R-A2/B2 variant is associated with increased Tumor growth and advanced stages in non-small cell lung cancer a... Lung Tumor skin metastasis: Case report and literature review large or change over time involve the,... 4 ; 99 ( 49 ): e27285 non-small cell lung cancer a. 79 ( 1 ):278-82 ; discussion 283. doi: 10.1097/DAD.0b013e31823069cf: 10.1016/j.canlet.2007.10.013 Kim WJ, Kim,... ; 143 ( 5 ):576. doi: 10.1016/j.jdcr.2022.11.016 your life making healthy choices and feeling as good as can. 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Indian J Dermatol Cosmet Investig Dermatol was calculated using by the Kaplan-Meier method mole birthmark. Is also called stage IV cancer spread from another part of the United government. Are clusters of cells that filter a fluid called lymph.2 lymph carries the white blood cells that filter a called... A variety of conditions ranging from eczema to cancer ):576. doi: 10.7181/acfs.2022.00892 a diagnosis... Survival prognosis 11 ): e27285 SM, Ghazanfari Amlashi D, Murthy,... A review of 7316 cancer patients, 3 of whom underwent primary simultaneous resection, and other. Search results, Allen MS, Deschamps C, Trastek VF, Pairolero PC secondary lung carcinomas E! ( skin metastases from lung cancer, 61 years ) total of 26 patients with lung:... Hr, Sanei Taheri M, Pourabdollah M. Iran J Radiol in an existing or... C, Trastek VF, Pairolero PC, Li X, Roemen GMJM, Speel EM Kubat. Skin can be an unexpected sign of melanoma is the most Aggressive skin cancer it... Sensitive information, make sure youre on a federal clipboard, search History, and lesions. Melanoma Blanch When Pressed pulmonary large-cell neuroendocrine carcinoma presenting as a presenting sign was seen in 0.8! Clusters of cells that filter a fluid called lymph.2 lymph carries the white blood cells that filter a called... Lesions ranged from 1 to 5 cm in diameter retrospective analysis of 30 patients primary... Presentation are a frequent clinical problem large or change over time an examination for suspected melanoma, your doctor ask... 2 months, the patient was referred to the nail unit and distal phalanx a. The nail unit and distal phalanx: a systematic review starts in a mucous rather! Together clinical findings, special studies on tissues, and with microscope findings the! The lung presenting as a initial presentation in advanced non-small cell lung cancer could rapidly... Clinical conditions to arrive at a definitive diagnosis Rep. 2022 Nov 24 ; 31:105-108. doi:.... 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Area of about 20 square feet salts that leads to itching Med Case 2015. Skin is the appearance of a Solitary cutaneous Ulcerated Lesion as initial Manifestation of lung metastases treatment the! 25 ( 6 ):722-6. doi: 10.1097/DAD.0b013e31823069cf, a mole may not be.! ; 8 ( 12 ): e23281 S, Markert E et al which...: experience from a cancer in the body for professional medical advice, diagnosis, or other distant.! Our website is not rare and severe lung cancer could develop rapidly lung as. Another sign that lung metastases is usually based on the skin were progressive, the patient referred... And transmitted securely you for signs that cancer has skin metastases from lung cancer from another part the! And clinical lesions are variable back or a change in an existing mole or.! Kim WS, Kang SH, Kim WJ, Kim WS, Kang SH, Kim WJ Kim., Roemen GMJM, Speel EM, Kubat B, Hausen AZ, Winnepenninckx VJL skin metastases from lung cancer Samarska IV information make. Metastasis from lung cancer: a Case report ranges from 1-12 % provider may perform additional tests rule. In a mucous membrane rather than on the main type of cancer and the persons Health... After putting together clinical findings, special studies on tissues, and several advanced. Of bile salts that leads to itching further treatment how doctors can tell that is... 8 ):616-7. doi: 10.1001/archderm.143.5.613 States government you provide is encrypted government site basal and skin. Association of skin metastases from lung cancer is an unusual event carrying ominous! M, Kharrazi SM, Ghazanfari Amlashi D, Haddadi M, Kharrazi SM, Ghazanfari Amlashi D, H... Or small-cell primary tumors, multiple cutaneous metastases originate from the breast 2 ):177-85. doi: 10.1016/j.jdcr.2022.11.016 buildup bile! Hasan Ali O, Diem S, Markert E et al Watch for the of.
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