Stephen Stone M.D. Professor of Dermatology, Southern Il University, Springfield, IL, USA on February 19, 2010
Excellent case presentation. The photomicrographs are very good. I would suggest the breast is only a presumptive source for these mets, and the search for a primary should be continued.
Ashok Sharma MD, Formerly Professor of Dermatology, Dr RP Government Medical College, Tanda, Kangra, HP, India on February 19, 2010
1. Considering the clinical presentation, history, physical examination and the histopath the diagnosis is quite valid.
2. Although I am not an expert pathologist however the histopath supported by special stains and markers does suggest presence of malignant cells.
3. I must complement you on your very thorough investigations in this patient (whatever she would permit). I don't see what else can be investigated.
4. An Oncologist's opinion is required. Considering her age, I am not sure if radiotherapy would help or prove intolerable. Also all management has to be as per her informed consent.
David Elpern MD, Dermatologist, Williamstown, MA, USA on February 19, 2010
A general dermatologist sees only occasional patients with cutaneous mets. These patients usually have more serious internal lesions. At 86 yo, I would not be aggressive. There is a role for palliation and not giving toxic meds nor incurring major expenses for the patient or her family. I would recommend an opinion from a dermatologic oncologist and a general oncologist and proceed slowly. Of course, the patient may not even want treatment at this point.
Khalid Al Hawsawi MD, Paediatric Dermatology Fellow,Sickkids' Hospital Toronto/Canada on February 19, 2010
Excellent case. I think this patient should be treated by oncologist.
Jag Bhawan M.D., Professor, Department of Dermatology and Pathology, Boston University School of Medicine, Boston, MA, USA on February 23, 2010
I agree that this is likely to be metastatic carcinoma. Breast is most likely the primary.
Ibrahim Misk MD, Dermatologist, Amman, Jordan on March 6, 2010
Thanks for the very nice case presented. I would refer him to an oncologist.