Widespread Cutaneous Metastases as the Primary Presentation of an Occult Neuroendocrine Tumour of Unknown Primary.

Cutaneous metastases from neuroendocrine neoplasms (NENs) are extremely rare even in advanced disease and may rarely be the initial presentation of an occult primary tumour. We describe a woman in her late 30s who presented with slowly growing skin lesions over a period of two years without associated systemic symptoms. She later developed abdominal discomfort, prompting hospital assessment. Clinical examination revealed extensive cutaneous nodules and a palpable abdominal mass. Imaging demonstrated widespread metastatic disease with multiple soft tissue deposits involving the liver, brain, and other deep organs. Histopathological examination of skin biopsies confirmed a grade 3 metastatic neuroendocrine tumour (NET) with a possible bronchial primary origin. The patient received systemic chemotherapy in addition to palliative radiotherapy for symptomatic lesions. Despite treatment, her condition progressively deteriorated due to the extensive disease burden, and management was subsequently redirected towards best supportive care with a focus on symptom control. This case highlights the diagnostic challenge posed by the variable cutaneous presentations of NENs, which can often be mistaken for benign growths without a high index of suspicion. This emphasises the importance of early recognition and biopsy of suspicious skin lesions.