Cutaneous metastasis from hepatocellular carcinoma after a percutaneous interventional procedure.

Cutaneous metastases from hepatocellular carcinoma are very uncommon, and, according to one series, account for just 0.8% of all cutaneous metastases. Iatrogenic factors appear to be the most common cause and include needle tract seeding during percutaneous interventional procedures and surface seeding of tumor cells during surgery. We present the case of a 35-year-old man with a history of chronic hepatitis C virus infection with progression to cirrhosis. He was subsequently diagnosed with hepatocellular carcinoma, which was treated with concomitant radiofrequency ablation and percutaneous ethanol injections. A year after treatment, the patient presented with a subcutaneous nodule in the right costal region (Figure 1). The site of the lesion appeared to coincide with that of the radiofrequency needle tract. Computed tomography showed a large lesion consistent with progression of the hepatocellular carcinoma on the right abdominal wall, in addition to multiple intrahepatic metastatic masses (Figure 2). Skin biopsy confirmed that the cutaneous lesion was a metastasis from the hepatocellular carcinoma (Figure 3). Surgical treatment and chemoembolization were ruled out because of the size of the lesion. The patient was administered chemotherapy (sorafenib) and radiation therapy in the scar area, but died 5 months after diagnosis of the cutaneous metastasis. Percutaneous interventional procedures have a very important role in the management of hepatocellular