Cutaneous metastasis of gastric adenocarcinoma at the site of a traumatic ecchymosis.

To the Editor: In a recent Cutis® article, Cesaretti et al1 reported a case of cutaneous metastasis from primary gastric cancer that appeared on a resection scar 6 years after remission and without any relapse of the primary tumor. We report a case of a 68-year-old man who was referred to the dermatology clinic with a 1520-cm nonpruritic, nonscaly, bruiselike lesion on the right forearm of 1 month’s duration. Approximately 1.5 years prior to presentation, the patient was diagnosed with gastric adenocarcinoma (stage IV: T4N3M1) with hepatic and lung metastasis. Following 6 months of chemotherapy with cisplatin and 5-fluorouracil, a positron emission tomography–computed tomography scan was performed and showed a reduction in metastasis but growth of the primitive tumor. After 1 year of chemotherapy, the new positron emission tomography– computed tomography scan showed no metastases. However, the primitive tumor had increased in size. One month prior to presentation to the dermatology department, a traumatic blood sample on the right forearm left the patient with a persistent ecchymosis. The lesion was thought to be a healing ecchymosis and no biopsy was performed. One month later, the skin lesion had become much thicker and more erythematous (Figure) but not larger. A skin biopsy of this well-defined plaque was performed. Histologic examination showed neovascularization, proliferative epithelial cells, and cytokeratin markers AE1/AE3 and CK20, leading to the diagnosis of skin metastasis of the gastric adenocarcinoma. Chemotherapy was