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Carcinoma erysipeloides (CE) is indeed an uncommon form of metastasis caused by superficial lymphatic spread of malignant cells to the overlying skin. The red thickened areas of skin may be mistaken for cellulitis or even eczema, thus delaying diagnosis. CE is caused by underlying adenocarcinoma most commonly from the breast, however it has been reported in cases of melanoma, head and neck cancers (parotid, thyroid, larynx), lung, ovary, prostate, pancreas and the stomach(1). Incision biopsy of the affected areas will confirm diagnosis and histopathological analysis will show malignant cells invading the cutaneous lymphatics.
I commend the author for highlighting an interesting case of CE secondary to triple negative breast cancer to raise awareness of its existence. The author concludes that CE associated with breast cancer has a poor prognosis and most survive only a few months after diagnosis. Survival rates following diagnosis of cutaneous metastasis have been to reported as a median of 13.8 months (2). This however is dependant on the histological subtype of the primary breast cancer and whether a multi-modal treatment approach has been employed. Treatment options include surgery, chemotherapy, radiotherapy and electrochemotherapy (ECT).
I would like to signpost the reader to the option of ECT for the treatment of cutaneous metastasis from breast cancer. ECT combines low dose chemotherapy which is administered intravenously or intramurally with electrical currents delivered directly into the affected skin areas via metallic probes. The electrical current transiently increases cellular membrane permeability to the chemotherapy thus increasing its cytotoxic action at lower systemic dosing.
ECT is suitable for patients that have exhausted other treatments; where surgery is not suitable or have extensive disease. It can improve quality of life by controlling painful, bleeding or ulcerating lesions. Studies have shown an objective response rate of 71-79% and complete response rate of 42-64.3% (3,4,5). Side effects include pain which is usually short lived (although some experience longer-term neuropathic pain), skin pigment changes, rash, swelling and general anaesthetic/sedation risks. Despite the side effects, ECT has been shown to improve quality of life for patients with cutaneous metastases from breast cancer and should be considered a worthy contender for localised disease control.
1. Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: A meta-analysis of data. South Med J. 2003;96:164–7
2. Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Survie après métastases cutanées: étude de 200 cas [Survival after cutaneous metastasis: a study of 200 cases]. Ann Dermatol Venereol. 2001;128(12):1310-1315.
3. Wichtowski M, Murawa D, Czarnecki R, Piechocki J, Nowecki Z, Witkiewicz W. Electrochemotherapy in the Treatment of Breast Cancer Metastasis to the Skin and Subcutaneous Tissue - Multicenter Experience. Oncol Res Treat. 2019;42(1-2):47-51. doi:10.1159/000494093
4. Bourke MG, Salwa SP, Sadadcharam M, et al. Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: Ten-year audit of single centre experience. Breast Cancer Res Treat. 2017;161(2):289-297. doi:10.1007/s10549-016-4046-y
5. Matthiessen LW, Keshtgar M, Curatolo P, et al. Electrochemotherapy for Breast Cancer-Results From the INSPECT Database. Clin Breast Cancer. 2018;18(5):e909-e917. doi:10.1016/j.clbc.2018.03.007
Re: Rash Refractory to Treatment. Mark Eisner. BMJ 2020;369:m1703
Dear Editor,
Carcinoma erysipeloides (CE) is indeed an uncommon form of metastasis caused by superficial lymphatic spread of malignant cells to the overlying skin. The red thickened areas of skin may be mistaken for cellulitis or even eczema, thus delaying diagnosis. CE is caused by underlying adenocarcinoma most commonly from the breast, however it has been reported in cases of melanoma, head and neck cancers (parotid, thyroid, larynx), lung, ovary, prostate, pancreas and the stomach(1). Incision biopsy of the affected areas will confirm diagnosis and histopathological analysis will show malignant cells invading the cutaneous lymphatics.
I commend the author for highlighting an interesting case of CE secondary to triple negative breast cancer to raise awareness of its existence. The author concludes that CE associated with breast cancer has a poor prognosis and most survive only a few months after diagnosis. Survival rates following diagnosis of cutaneous metastasis have been to reported as a median of 13.8 months (2). This however is dependant on the histological subtype of the primary breast cancer and whether a multi-modal treatment approach has been employed. Treatment options include surgery, chemotherapy, radiotherapy and electrochemotherapy (ECT).
I would like to signpost the reader to the option of ECT for the treatment of cutaneous metastasis from breast cancer. ECT combines low dose chemotherapy which is administered intravenously or intramurally with electrical currents delivered directly into the affected skin areas via metallic probes. The electrical current transiently increases cellular membrane permeability to the chemotherapy thus increasing its cytotoxic action at lower systemic dosing.
ECT is suitable for patients that have exhausted other treatments; where surgery is not suitable or have extensive disease. It can improve quality of life by controlling painful, bleeding or ulcerating lesions. Studies have shown an objective response rate of 71-79% and complete response rate of 42-64.3% (3,4,5). Side effects include pain which is usually short lived (although some experience longer-term neuropathic pain), skin pigment changes, rash, swelling and general anaesthetic/sedation risks. Despite the side effects, ECT has been shown to improve quality of life for patients with cutaneous metastases from breast cancer and should be considered a worthy contender for localised disease control.
1. Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: A meta-analysis of data. South Med J. 2003;96:164–7
2. Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Survie après métastases cutanées: étude de 200 cas [Survival after cutaneous metastasis: a study of 200 cases]. Ann Dermatol Venereol. 2001;128(12):1310-1315.
3. Wichtowski M, Murawa D, Czarnecki R, Piechocki J, Nowecki Z, Witkiewicz W. Electrochemotherapy in the Treatment of Breast Cancer Metastasis to the Skin and Subcutaneous Tissue - Multicenter Experience. Oncol Res Treat. 2019;42(1-2):47-51. doi:10.1159/000494093
4. Bourke MG, Salwa SP, Sadadcharam M, et al. Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: Ten-year audit of single centre experience. Breast Cancer Res Treat. 2017;161(2):289-297. doi:10.1007/s10549-016-4046-y
5. Matthiessen LW, Keshtgar M, Curatolo P, et al. Electrochemotherapy for Breast Cancer-Results From the INSPECT Database. Clin Breast Cancer. 2018;18(5):e909-e917. doi:10.1016/j.clbc.2018.03.007
Competing interests: No competing interests