Lung Cancer Symptoms On The Skin To Watch For
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
Skin symptoms can be an unexpected sign of lung cancer. With most types of lung cancer, people don’t show signs until it has spread. But lung cancer can also cause other syndromes that can lead to additional problems seen on the skin.
This article will discuss how lung cancer can affect the skin, symptoms to look for, and skin changes that may occur during treatment for lung cancer.
Verywell / Jessica Olah
Earlier Detection Methods Are Needed
Our findings highlight the need for earlier detection of cancer, Dr. Curtis said.
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.
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.
This is early-stage research, but it gives us the first quantitative evidence that metastasis can occur exceedingly early, while also providing clues as to how to identify individuals who are at risk of metastasis, Dr. Curtis said.
Before the new results can be used to guide patient care, the researchers will need to look at a much larger group of patients, to see how consistent their findings are, Dr. Boudreau said.
Indeed, Dr. Curtis said, her team plans to extend their analysis to more patients. 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. And then, if thats true, we will have a rationale to go forward with clinical studies.
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What Are The Signs And Symptoms Of Cutaneous Metastasis
Most cutaneous metastasis occurs in a body region near a primary tumour. The first sign of the metastasis is often the development of a firm, round or oval, mobile, non-painful nodule. The nodules are rubbery, firm or hard in texture and vary in size from barely noticeable lesions to large tumours. These may be skin coloured, red, or in the case of melanoma, blue or black. Sometimes multiple nodules appear rapidly. The skin metastases may break down and ulcerate through the skin. Specific patterns include:
- Carcinoma erysipeloides: sharply demarcated red patch due to local spread of primary cancer blocking lymphatic blood vessels in adjacent skin
- En cuirasse or sclerodermoid carcinoma: indurated fibrous scar-like plaques due to cancer cells infiltrating collagen in the skin
- Carcinoma telangiectoides: red patches with numerous blood vessels or lymphatic vessels .
Depending on the location of the primary tumour, cutaneous metastasis display certain characteristic features.
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Coping With A Nsclc Diagnosis
For most patients, a diagnosis of NSCLC is extremely stressful. Some people who are diagnosed with NSCLC develop anxiety and, less commonly, depression. You and your families should not be afraid to talk with the health care team about how you feel. The health care team has special training and experience that can make things easier for patients and their families and is there to help.
In addition to providing information and emotional support, your doctor may include supportive services and palliative care specialists in your care. This team could include a counselor, psychologist, social worker, or psychiatrist.
You and your family may also find resources available in the community to help people living with lung cancer, such as support groups. Some patients feel comfortable discussing their disease and experiences throughout treatment with their health care team, family, friends, or other patients through a support group. These patients may also join a support group or advocacy group in order to increase awareness about lung cancer and to help fellow patients who are living with this disease.
A NSCLC diagnosis is serious. However, doctors can offer effective treatment for the cancer. In addition, advances being made in the diagnosis and treatment of NSCLC that provide more and more patients with a chance for a cure.
Learn more about the counseling, finding a support group, and being a cancer advocate.
How Does The Doctor Know I Have Skin Cancer
Basal and squamous skin cancer may look like:
- Flat, firm, pale or yellow areas that look a lot like a scar
- Raised reddish patches that might itch
- 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
- Wart-like growths
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Not Just Skin Deep: Small Cell Carcinoma Presenting As Skin Metastases
Beverly Patuwo Lee, MD, MPH Jonathan Huang, MD and Lee B. Lu, MD
Beverly Patuwo Lee, MD, MPH Jonathan Huang, MD and Lee B. Lu, MD
Citation:Lee BP, Huang J, Lu LB. Not just skin deep: small cell carcinoma presenting as skin metastases. Consultant. 2017 57:348-350.
Skin metastases rarely present as the initial clinical manifestation of an underlying small cell carcinoma of the lung. The presence of such dermatologic findings signifies an advanced stage of disease progression and carries a poor prognosis. Therefore, it is crucial for clinicians to understand its significance and to perform early biopsies of any suspicious skin lesions. This late stage of progression is typically deemed incurable, and treatment with chemotherapy is the only option known to slow the progression of disease. We report a case of multiple cutaneous metastases in a previously healthy woman who was later found to have small cell carcinoma, likely originating in the lungs, along with additional organ involvement.
Case Report
A 28-year-old woman presented for evaluation of worsening left lower extremity swelling, pain, and the appearance of multiple nodules and masses on her body over the past 6 months. One month prior to presentation, she reported having received a diagnosis of neurofibromatosis from an outside physician. She denied any known family history of malignancies or dermatologic conditions. She denied any history of smoking.
Figure 4. Irregular erythematous masses on the scalp.
Some Colorectal Tumors Are Born To Be Bad
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.
We could then compare the simulated data with the observed patient data using various statistical techniques, Dr. Curtis explained.
The modeling data indicated that metastasis begins very early during tumor developmentwhen the primary tumor is smaller than the tip of a sharpened pencil.
In other words, Dr. Curtis said, some tumors may be âborn to be bad.
The team next investigated whether the results from their small set of paired samples of primary and metastatic tumors from patients could be extended to a larger number of patients.
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. The primary tumors of these patients had been profiled to identify genetic changes in known cancer-associated genes.
This analysis showed that certain genetic changes tend to occur together, and that specific combinations of three to five mutations were more common in patients with metastatic cancer than in those with nonmetastatic disease, suggesting that specific combinations of early genetic changes confer the potential for tumor cells to spread.
If confirmed in future studies, this information could potentially be used to guide treatment decisions, she said.
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Skin Symptoms During Treatment
Treatment will differ depending on the type and severity of lung cancer. Some of the treatment options for lung cancer can also cause skin symptoms.
- Radiation therapy can cause a redness of the skin that looks and feels like sunburn. It can be quite painful.
- Chemotherapy can lead to skin bruising or bleeding easily due to low blood platelet counts.
- Immunotherapy medications such as Keytruda and Opdivo might cause changes to the skin, such as dryness or itching. Skin eruptions and itching have been reported in approximately 10% or more of patients treated with Opdivo.
Targeted therapy medication can also cause various skin problems. Examples of some of these types of drugs and the side effects they have on the skin include:
- Giotrif : Acne-like rash to the head, chest, and back sore and red palms of hands and soles of feet
- Iressa : Dry, itchy, and flaky skin
- Tarceva : Dry, itchy, flaky skin acne-like rash on the face severe reactions that may cause blistering and peeling skin
- Vargatef : Tiny red or purple spots on the skin that may resemble a rash
- Xalkori : Itchy rash
- Zykadia : Itchy rash, dryness
What Are The Symptoms Of Melanoma That Has Spread
Melanoma that has spread from the skin to other areas of the body is known as metastatic melanoma. However, since melanoma often first presents itself as an abnormal mole, many people with this malignancy can receive a diagnosis before the cancer has spread. This mole may be asymmetrical, have an uneven border, have an inconsistent color, be large or change over time. A melanoma may also appear as a sore or itchy bump, a tender nodule or a patch of skin that is scaly or bleeding. In some cases, early signs of melanoma are not present. For example, if the cancer starts in a mucous membrane rather than on the skin, a mole may not be present.
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Red Flag #: Unexplained Weight Loss And Loss Of Appetite
Unintentional weight loss is a common side effect of any cancer. When it comes to melanoma, extreme weight loss usually only happens after the cancer has spread from the skin to other parts of the body. Dr. Zaba says she can sometimes tell if a patients melanoma has metastasized because it looks like they have cachexia, a syndrome marked by drastic loss of fat and muscle and increased weakness. Cachexia can also cause loss of appetite, which further contributes to the problem.
Symptoms If Cancer Has Spread To The Bone
You might have any of the following symptoms if your cancer has spread to the bones:
- pain from breakdown of the bone the pain is continuous and people often describe it as gnawing
- backache, which gets worse despite resting
- weaker bones they can break more easily
- raised blood calcium , which can cause dehydration, confusion, sickness, tummy pain and constipation
- low levels of blood cells blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding
Cancer in the spinal bones can cause pressure on the spinal cord. If it isnât treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control . This is called spinal cord compression. 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.
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Biomarker Testing Of The Tumor
Your doctor may recommend running tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor.
There are several genes that may have changes, called mutations, in a lung tumor that can help the cancer grow and spread. These mutations are found in the tumor only and not in healthy cells in the body. This means these types of mutations are not inherited or passed down to your children.
Results from these tests and information about the stage of NSCLC you have can help determine if you can receive targeted therapy, which can be directed at specific mutations . Targeted therapies now exist for many different genetic mutations that are known to cause lung cancer and research is ongoing to develop more .
Genetic mutations that are known to contribute to lung cancer growth often occur on 1 or more of several genes, including EGFR, ALK, KRAS, BRAF, HER2, ROS1, RET, MET, and TRK and testing the tumor for these genes is now common. Certain mutations that can be treated with targeted therapy are much more likely to occur in people with adenocarcinoma NSCLC and those who never smoked. However, people whose have a history of smoking may also have genetic mutations that can be treated with targeted therapy, therefore, it is essential to test for molecular mutations, regardless of a history of smoking.
Distinguishing Metastases From Primary Tumors
Certain attributes distinguish metastases from primary tumors. Some features include neoplastic cells in lymphatic and blood vessels, a large portion of neoplasm in the deep reticular dermis, and subcutaneous fat and neoplastic cells lined up between collagen bundles.
Metastatic tumors are usually round, discrete tumor lobules in the dermis, with a Grenz zone, and are usually unassociated with the epidermis. Physical patterns vary among different carcinomas. Fibrosis and inflammation may be present. Vascular involvement is rare. Sometimes, unusual patterns can be identified.
Paget disease typically has a distinct clinical and histologic presentation, with involvement of the nipple or the areola. Symptoms may include an eczematous patch, with intense scaling, pain, and bleeding in later stages. Paget disease may be a sign of underlying breast, genitourinary, or colon cancer, or it may be a primary neoplasm of indeterminate glands in the skin. In extraordinary situations, lesions may be pigmented and epidermotropic and simulate melanoma.
Some primary melanomas may arise in the dermis and simulate a metastasis. On the other hand, some metastases may be epidermotropic and simulate a primary epidermal tumor.
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How Do You Detect Lung Cancer Symptoms
Lung cancer symptoms might not always be evident at first. There is often a significant delay between the onset of symptoms and the diagnosis of lung cancer. You are more at risk for lung cancer if you smoke. It can be easy to dismiss symptoms if you have never smoked. However, lung cancer can affect anyone at any age.
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. It’s always better to see your doctor to rule out or confirm a diagnosis, as lung cancer can often go undetected until the later stages, when treatments are less effective.
Outlook Once Cancer Has Spread To The Bones
The research on cancer metastasis is rapidly growing. As researchers better understand the mechanisms of bone metastasis, new drugs and other treatments are being developed. These target particular processes in cells involved in how the cancer cells invade and grow in bones.
The use of nanoparticles to deliver drugs is very encouraging. These tiny particles are able to deliver drugs to the bone with minimal toxicity to the person with cancer.
Rapidly treating bone metastasis can lead to a
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What Is Electrochemotherapy
Electrochemotherapy combines a low dose of a chemotherapy drug with electrical impulses. Its given to help with the symptoms of skin metastases.
Studies have shown that electrochemotherapy can:
- Help stop bleeding, broken skin and pain
- Reduce the size of skin metastases
Using electrical impulses allows the chemotherapy to work in the treated areas only, with little or no effect in other areas.
Electrochemotherapy wont treat any other areas of secondary breast cancer inside the body.
How Is Lung Cancer Treated
Treatment will differ depending on the type and stage of the lung cancer. Examples of lung cancer treatment include:
- Surgery: To remove cancerous tissues
- Chemotherapy: Medication to help shrink or kill cancer
- Radiation therapy: High doses of radiation to kill cancer cells
- Targeted therapy: Medications to stop the spread and growth of cancer and reduce damage to healthy cells
- Immunotherapy: Stimulating the immune system to help fight cancer
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Treatment Of Lung Metastases
Treatment for lung metastases is usually based on the main type of cancer the person has. Treatment may include chemotherapy,immunotherapy or radiation therapy, or a combination of these.
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. Also, surgery would only be used if the main cancer is under control.
Controlling symptoms is important, especially if treatment for the main cancer is not effective or may take a while to help. Shortness of breath can be one of the hardest feelings to deal with. Morphine-like medicines can be used to help decrease the feeling of shortness of breath. Anti-anxiety medicines may be helpful if the morphine-like medicines dont work.
Having trouble breathing can make you feel anxious, worried, and even like you are in a panic. Some patients find the steps below helpful.
- A fan blowing cool air on you
Pain can also be hard to deal with, especially if you have other symptoms. Talk to your healthcare team about how you can use medicines and supportive methods to treat your pain.
Tests For Skin Metastases
A member of your treatment team will examine you and look at your skin. Theyll also discuss any other symptoms you have.
To confirm a diagnosis of secondary breast cancer in the skin, you may have a punch biopsy. Youll be given a local anaesthetic before a tiny cutter device is used to take a very small piece of tissue from the area. Its not unusual for the area to bleed a little after the biopsy so a small dressing or plaster will be applied.
The biopsy site may be uncomfortable for a little while, but simple pain relief can be taken to help with this.
You may also have a CT scan to check for any signs of the cancer having spread to other parts of the body.
A CT scan uses x-rays to take a series of detailed pictures of the body. Its painless but during the CT scan you need to lie still for a short period of time. Before the scan you may be given a liquid known as a contrast solution. This is usually injected into a vein, and helps produce clearer images to identify the number, size and location of any areas of cancer.
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