Review of the literature regarding metastatic prostate carcinoma to the skin, "Beyond the Abstract," by Gabrielle E. Brown, MS, et al

BERKELEY, CA ( - Metastasis of internal malignancy to the skin is an uncommon phenomenon that represents 2% of all skin tumors.[1] Prostate cancer rarely metastasizes to the skin, and primary urologic malignancy is estimated to represent less than 1% of cutaneous metastasis in men.[2] We previously reported a case of an 81-year-old man with a history of prostate cancer that presented with multiple metastatic nodules of the scalp and face.[3] Herein we review 77 cases of metastatic prostate cancer to the skin in the literature to better understand associated clinical features and prognosis.

Features of primary malignancy

Adenocarcinoma is the most common histological subtype of prostate cancer, which comprises the vast majority of cutaneous metastasis reported in the reviewed cases (91.0%). Rare subtypes resulting in cutaneous metastasis include small cell carcinoma (3.8%),[4, 5, 6] transitional cell carcinoma (2.6%),[7, 8] and a mucinous adenoma subtype with signet ring cells (1.3%).[9] More than one type of histological subtype was present in 2 cases (2.6%). The Gleason grade was disclosed in 31.0% of reviewed cases, with an average score of 7.8 in patients with cutaneous metastasis.

Cutaneous onset

Skin eruption is often abrupt and progressive with onset of cutaneous metastasis appearing at any point in the disease course. The average age at cutaneous onset was 69.6 years, ranging from 50 to 90 years. On average, cutaneous eruption occurred 54.4 months after initial prostate cancer diagnosis with cases ranging from 3 to 192 months. In 11 cases (14.3%), the cutaneous eruption was the presenting sign alerting the physician to the presence of the primary prostatic cancer.[5, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]

Clinical features

The clinical features of cutaneous metastasis varied among the different cases, but may be classified into distinct morphological groups. Most cases (N=53, 68.8%) reported a nodular morphology, generally characterized by multiple skin-colored, firm fleshy nodules. The clinical appearance of nodular eruptions often resembled other primary dermatologic conditions. Examples include basal cell carcinoma,[18, 19] epidermoid cyst,[15, 20] pyoderma,[21] trichoepithelioma,[22] extramammary Paget’s disease,[23] and Sweet’s Syndrome.[24] The nodular pattern has also been described to occur in a zosteriform distribution.[11, 25]

A morphological variant of violaceous or erythematous plaques was frequently observed (N=11, 14.1%). This form was reported to clinically resemble angiosarcoma,[26] inflammatory breast cancer,[14] or morphea[27] in select cases. This particular clinical morphology was associated with the histologic finding of malignant cells in dermal lymphatic vasculature, also known as carcinoma erysipeloides.[12, 28, 29] Anatomical locations of the cutaneous eruption varied from local near the primary site to distant involvement of the head and neck. The chest was the most commonly involved site (N=21, 27.3%), followed by the penis (N=17, 22.1%) and scalp (N=13, 16.9%). Cutaneous metastasis was also reported to occur on the neck (N=10, 13.0%) and face (N=9, 11.7%). The genital region was frequently involved, including the suprapubic and inguinal areas, as well as the scrotum (for each anatomical location, N=8, 10.4%). There are several reported cases of nodules located in the umbilicus, also known as Sister Mary Joseph nodules (N=5, 6.4%). More than one anatomical site was involved in 39.0% of cases. The anatomical site increased suspicion for other conditions, including a rare case in the perianal region mistaken for a primary anal cancer.[30] One case reported cutaneous metastasis that arose at the site of a transabdominal laparoscopic surgery, which was believed to implant during the surgical manipulation of metastatic pelvic lymph nodes.[31]

In patients presenting with cutaneous metastasis, metastatic disease was frequently identified in additional sites. Osseous and lymphatic involvement were the most common (50.6% and 27.3% of all cases, respectively). Select cases reported metastasis to unusual organs, including the paraspinal muscle confirmed with biopsy,[28] and cardiac, pericardiac, and pancreatic metastasis on postmortem examination.[32] More than one visceral metastatic site was identified in 32.5% of cases. On average, patients expired 5.9 months after cutaneous onset.


Consistent with previous reports, our review of 77 cases revealed that adenocarcinoma is the most common primary prostatic malignancy with metastatic potential to the skin. As would be expected with advanced disease, the histological findings of the primary malignancy according to Gleason score were relatively high grade. However, Gleason scoring is a newer construct and many of the earlier case reports did not include such information. Although the cutaneous eruption was the first sign of visceral malignancy in several cases, the onset of cutaneous metastasis occurred, on average, over 4 years after the original diagnosis of prostate cancer. Cutaneous metastasis comprises a wide morphologic spectrum that may resemble common primary dermatologic conditions. Previous reports emphasized cutaneous metastasis of prostate cancer to urogenital structures, however we found that involvement of distant anatomical sites, such as the chest, face, and neck, are commonly reported. Consistent with previous observations, cutaneous metastasis is associated with a poor prognosis with average survival 5.9 months after the onset of the cutaneous eruption. Given the poor prognosis, it is important for providers to consider the possibility of cutaneous metastasis in a patient with a known history of prostate cancer with a new onset skin eruption.


Author Year Age Type of malignancy Gleason grade Time to CO after prostate cancer diagnosis Clinical morphology Additional description Location Other metastases Outcome
Abrol[33] 2011 51 A 9 NR Nodular   Neck, chest Lymphatic NR
Ali[34] 2002 65 A NR NR Pedunculated   Scalp, face, upper extremity ND Death 4 months after CO
Arita[35] 2002 88 A 9 2 years Nodular   Suprapubic region Lymphatic NR
Azana[10] 1993 70 A NR Prostate CA diagnosed at CO Nodular   Neck NR NR
Bailey[36] 2007 69 A 9 12 months Nodular   Penis, scrotum ND Death 9 months after CO
Bangma[31] 1995 66 A NR 39 months Nodular   Abdomen (operative site) Lymphatic, osseous Death 2 months after CO
Bluefarb[11] 1957 67 A NR Prostate CA diagnosed at CO Nodular Zosteriform distribution Lower extremity Hepatic, lymphatic, pulmonary, osseous Death 2 months after CO
Boswell [26] 2005 62 A NR 7 years Violaceous plaque Resembled angiosarcoma Scalp Osseous Death 6 weeks after CO
Brown & Kurtzman [3] 2014 81 A NR 4 years Nodular   Scalp, face Osseous Modest regression of cutaneous metastasis with hormonal treatment
Brown [37] 2014 73 A 7 2 years Violaceous plaque   Chest Lymphatic, osseous Death 1 year after CO
Cabria[38] 1999 81 A NR 11 years Nodular   Penis Osseous Death 5 months after CO
Cai[39] 2007 72 A 6 5 years Nodular   Penis Lymphatic, osseous Death 20 months after CO
Cecen[4] 2014 80 A, SCCP 4 6 years Subcutaneous mass   Back Hepatic Death from MI
Collina [18] 2011 78 A NR NR Nodular Resembled BCC Neck NR NR
Colovic[40] 2009 65 A NR 7 months Nodular   Scrotum NR Death 2 months after CO
Cox [12] 1994 56 A NR Prostate CA diagnosed at CO Violaceous plaques Carcinoma erysipeloides Inguinal region, lower extremity NR Death 1 year after CO
Delima [13] 1973 61 A NR 15 months Nodular   Suprapubic region, lower extremities Genitourinary Death within 12 weeks of CO
65 A NR Prostate CA diagnosed at CO Nodular   Back, suprapubic region Osseous Death within 12 weeks of CO
Devender [41] 2009 50 A 7 NR Nodular   Scalp, face Osseous, neurologic NR
Fiorelli [42] 1989 73 A NR 5.5 months Edema   Penis, scrotum NR NR
Fukuda [43] 2006 80 A NR 9 years Nodular SMJ Umbilicus Osseous Death 2 months after CO
Gupta [44] 2013 70 A 6 “few months later” Nodular   Suprapubic region, inguinal region, penis, scrotum Genitourinary Lost to follow-up
Hunek [25] 2005 70 A NR NR Nodular Zosteriform distribution Chest Osseous NR
Katske[45] 1982 64 A NR NR Nodular   Abdomen ND Patient committed suicide soon after CO
59 A NR NR Nodular   Chest Lymphatic NR
Keen[46] 2013 70 A 9 1 year Nodular   Lower extremity, suprapubic region, inguinal region Osseous NR
Kim[24] 2010 71 A NR 5 years Nodular Sweet’s panniculitis Upper extremity, chest Osseous Cutaneous metastases resolved with systemic steroids
Kobashi[47] 2009 64 A NR 6 years Erythematous plaque   Penis Neurologic, pulmonary Death 4 months after CO
Kotake[48] 2001 58 A 9 29 months Nodular   Penis Lymphatic, osseous No PSA elevation following partial penectomy at 3 months
Kraft[5] 2013 60 SCCP NR Prostate CA diagnosed at CO Violaceous ulcerated mass   Scalp Hepatic, osseous, pulmonary Death 4 months after CO
Kremer[30] 2012 71 A 9 7 months Nodular   Perianal NR Death 2 months after CO
Krishna[49] 1997 60 A NR NR Nodular   Chest, abdomen Hepatic NR
Landow[50] 1980 57 A NR 4 months Nodular   Scalp, face Osseous, pulmonary Death 1 month after CO
56 A NR 4 years Nodular Resembled Virchow’s node Neck (supraclavicular fossa) Osseous Death 7 months after CO
Leonard[51] 2003 74 A 7 NR Erythematous plaque   Chest Lymphatic, osseous Death 2 months after CO
Lopez-Navarro[9] (see table in paper) 2009 62 A (mucinous with signet ring cells) 8 Prostate CA diagnosed at CO Nodular   Face, chest, axilla Genitourinary, lymphatic, osseous Progressive reduction in cutaneous lesions with hormonal therapy
Marcoval[52] 1998 69 A NR 3 years Nodular   Chest, nipple Osseous Death 3 months after CO
Mishra[7] 2001 68 TCCP NR NR Nodular SMJ Umbilicus NR Death 1 month after CO
Mueller[2] 2004 77 A 7 3 years Violaceous plaque   Chest Osseous Death 9 months after CO
Nason[53] 2012 90 A 10 11 months Papular   Penis NR Cutaneous lesions did not respond to hormonal therapy at 3 months
Ng[28] 2000 72 A NR 7 years Erythematous plaques Carcinoma erysipeloides Lower extremity Lymphatic, muscular Progression of cutaneous lesions 18 months later
Njiaju[14] 2010 78 A NR Prostate CA diagnosed at CO Erythema and edema Resembled inflammatory breast cancer Chest Osseous Cutaneous eruption improved following hormonal therapy, but went on hospice
Offidani[15] 1997 66 A NR Prostate CA diagnosed at CO Nodular Resembled epidermoid cyst Scalp, chest Pulmonary NR
Ogunmola[16] 2013 62 A 6 Prostate CA diagnosed at CO Nodular   Neck, chest, abdomen, suprapubic NR Lost to follow-up
Oka [54] 1982 77 A NR 16 months Nodular   Chest, penis Lymphatic, osseous, pulmonary, hepatic Death 6 months after CO
Osther [55] 1991 76 A NR 3 months Edema   Penis Hepatic, pleural, pulmonary Death 6.5 months after CO
78 A NR 4 years Edema   Penis Osseous Hormonal therapy prevented metastatic progression at 4 months after CO
Owen [56] 2009 67 NR 9 8 years Nodular   Scalp, face, neck, upper extremity, flank Lymphatic, osseous, pulmonary Patient on hospice 9 months after CO
Paz-Ares [57] 2001 67 NR NR NR Nodular   Scalp, neck, chest, inguinal region Lymphatic, osseous Death 2 months after CO
Peison [20] 1971 60 A NR 3 years Nodular Resembled epidermoid cyst Scalp ND Death 3 months after CO
Petcu 23 2012 63 A 6 16 years Nodular Extramammary Paget’s disease Scalp, abdomen, inguinal region Lymphatic Death 3 weeks after CO
Pieslor [58] 1986 80 A NR NR Nodular SMJ Umbilicus Osseous Death 1 month after CO
Pique [27] 1996 64 A NR NR Erythematous plaque Resembled morphea Chest Osseous Death 6 weeks after CO
Pistone [59] 2013 78 A NR 8 years Nodular   Chest NR NR
Powell [60] 1984 70 A NR NR Induration   Penis Genitourinary Death 2 years after CO
72 A NR NR Nodular   Penis Osseous, pulmonary, hepatic, genitourinary Death 2 years after CO
65 A NR 7 months Nodular   Penis Osseous, pulmonary, hepatic Cutaneous metastasis cleared following chemotherapy
Rattanasirivilai [61] 2011 78 A 7 5 years Hemorrhagic nodules Resembled vascular proliferation Suprapubic region, inguinal region, scrotum, penis Osseous Resolution of cutaneous lesions 9 months after hormonal therapy
Ray [62] 1978 73 A NR 5 years Nodular   Penis, scrotum Lymphatic, osseous Death 1 year after CO
Razvi [8] 1975 73 TCCP NR Prostate CA diagnosed at CO Nodular   Face, abdomen NR NR
Reddy [63] 2007 83 A NR 12 years Violaceous plaque   Chest NR Death 6 months after CO
Rossetti [19] 1991 63 A NR 3 years Nodular Resembled BCC Chest NR NR
Schellhammer [32] 1973 66 A NR 2 years Nodular   Abdomen, lower extremities Osseous Death 6 months after CO
59 A NR 6 months Nodular   Scalp Cardiac, lymphatic,Osseous, pancreatic, pericardiac, pleural Death 4 months after CO
Senkul [64] 2002 76 A 7 10 years Nodular   Penis Osseous Improvement in cutaneous lesions with chemotherapy
Sharma [22] 2010 64 A NR 5 years Nodular Resembled trichoepithelioma Face, neck, chest NR Lost to follow-up
Sina [65] 2007 65 A 10 3 years Nodular SMJ Umbilicus NR Death 4 months after CO
Slovin [29] 2006 81 A NR 16 years Violaceous plaque Carcinoma erysipeloides Lower extremities ND NR
Stahl [21] 1980 86 NR NR 7 years Nodular Resembled pyoderma Upper extremities Osseous Death 1 year after CO
Stanko [66] 2007 80 A NR NR Nodular SMJ Umbilicus ND NR
Steinkraus [67] 1995 79 A NR 1 year Nodular   Inguinal region NR Death 4 months after CO
Van Meter [68] 2010 67 A 9 8 years Nodular   Scalp, face, neck, flank, upper extremity Osseous, pulmonary Death 1 year after CO
Wang [69] 2008 56 A 9 31 months Xanthomatous papules with edema   Suprapubic region, scrotum Lymphatic, osseous NR
Wu [70] 2006 75 A NR 13 years Nodular   Chest NR Stable lesions with conservative treatment at 6 months
Venable [17] 1983 81 A NR Prostate CA diagnosed at CO Subcutaneous mass   Neck Lymphatic, pleural, pulmonary Death 3 months after CO
78 A NR 1 year Violaceous plaque   Abdomen, inguinal region Lymphatic Death 3 weeks after CO
Yildirim [6] 2008 60 A, SCCP 9 11 months Papular   Scrotum Lymphatic Death shortly after CO

A – adenocarcinoma
SCCP – small cell carcinoma of the prostate
TCC – transitional cell carcinoma
BCC – basal cell carcinoma
SMJ – Sister Mary Joseph
CO – cutaneous onset
NR – not reported
ND – none detected 



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Written by:
Gabrielle E. Brown, MS;a Drew Kurtzman, MD;b Elizabeth A. Tourville, MD;c James Sligh, MD, PhDb as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

aCollege of Medicine, University of Arizona, Tucson, AZ USA
bDivision of Dermatology, University of Arizona, Tucson, AZ USA
cDepartment of Urology, University of Tennessee Health Sciences Center, Memphis, TN USA

Gabrielle Brown
1515 N. Campbell, #1909
Tucson, AZ USA  85719

Eruptive nodules of the head and neck: A case report of metastatic prostate cancer - Abstract

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