Cutaneous metastasis as first clinical manifestation of signet ring cell gastric carcinoma.

Cutaneous metastases from signet ring cell gastric carcinoma are uncommon. A 69-year-old man presented with a 15-day history of an asymptomatic indurated scar-like lesion. The biopsy revealed an infiltrating signet ring cell carcinoma consistent with gastric metastasis. Gastroscopy and biopsy showed gastric carcinoma with signet ring cells; subsequent computed tomography revealed metastatic nodules in the liver, mesentery, and retroperitoneal and peripancreatic lymph nodes. A review of the 10 cases of cutaneous metastasis from signet ring cell carcinoma in the literature revealed that cutaneous metastases of gastric origin usually appear at earlier ages than in our patient and that the primary tumor is unknown at the time of skin biopsy in 64 percent of cases. The present report describes the unusual clinical-diagnostic sequence of a patient diagnosed with cutaneous metastasis before detection of his gastric carcinoma.