Cutaneous metastases of pancreatic carcinoma as a first clinical manifestation.

Cutaneous metastases from pancreatic adenocarcinomas are rare lesions. The most common site of cutaneous metastasis is the umbilicus, and this is also known as the 'Sister Mary Joseph' nodule. A 68-year-old Korean male, who was previously healthy and asymptomatic, was seen in the dermatology department for two subcutaneous nodules that he had on his right forearm and his back. Histological examination of the right foreman nodule revealed metastatic adenocarcinoma. Immunohistochemical staining for cytokeratin (CK) 7 and CK 19 were positive, and this strongly suggested the pancreatic duct as being the primary source of the cancer. The abdominal computed tomography findings were compatible with pancreatic cancer. Clinicians should be aware that metastatic cutaneous lesions could be the initial presenting sign for pancreatic cancer. The immunohistochemical staining for CK 7 and 19 may also be helpful in the diagnosis of metastatic pancreatic adenocarcinoma.