Cutaneous metastasis: a rare herald of a silent cancer.

A 59-year-old previously healthy man with a 50-pack-year smoking history presented with rib pain 1 month after a mechanical fall. Physical examination revealed a 1.5 cm right cervical lymph node and a 0.9 × 0.9 cm scalp nodule. The patient had only noticed the scalp lesion a month prior to presentation. Chest X-ray revealed a 5.8 × 5.0 cm left infrahilar mass. CT angiography demonstrated extensive metastatic mediastinal and right hilar adenopathy as well as hepatic, right adrenal and brain lesions. Pathology from fine-needle aspiration of cervical lymph nodes and punch biopsy of the scalp lesion were consistent with non-small cell lung cancer (NSCLC) metastasis. The patient underwent brain stereotactic radiosurgery and palliative radiation therapy. Unfortunately, he passed away 4 months after diagnosis. Malignancy (primary or secondary) should be considered by clinicians in the work up of patients with new skin lesions, particularly in those at high risk of cancer. 2016 BMJ Publishing Group Ltd.