Prostate cancer is one of the most common malignancies affecting men globally, usually developing within the prostate gland. While in its early stages, the disease is often confined to the gland itself, advanced prostate cancer may spread to distant parts of the body such as the bones, lymph nodes, and, in rarer cases, the skin. When cancer cells reach the skin, this is known as cutaneous metastasis. These skin changes can sometimes resemble ordinary dermatological conditions, making them difficult to recognise. Identifying such symptoms early is vital, as it supports timely diagnosis, guides effective management, highlights disease progression, and aids in monitoring treatment response and overall patient prognosis.
Understanding cutaneous metastasis in prostate cancer: Spread of cancer cells to the skin
Cutaneous metastasis refers to the spread of cancer cells to the skin from a primary tumour located elsewhere in the body. In prostate cancer, this occurrence is uncommon but significant. A study published in Indian Journal of Dermatology indicates that skin metastases from prostate cancer are rare, with an incidence of approximately 0.36%
These skin lesions often appear in the later stages of prostate cancer and can serve as an indicator of advanced disease. The presence of skin metastases is associated with a poor prognosis, with average survival times of less than six months following the appearance of these lesions.
Common skin symptoms associated with prostate cancer
1. Nodules and papulesThe most frequent skin manifestations of prostate cancer metastasis are hard nodules or papules. These lesions are typically firm to the touch, raised above the skin’s surface, and may vary in size from a few millimetres to several centimetres. They are usually skin-coloured to reddish-brown and can sometimes mimic benign skin growths such as cysts or lipomas, which makes diagnosis challenging. Nodules most often appear on the chest, abdomen, and extremities, though they can occasionally develop near the genital area.2. Zosteriform distributionIn rare cases, cutaneous metastases may present in what is called a zosteriform distribution. This refers to skin lesions that appear in a band-like arrangement along a dermatome – the area of skin supplied by sensory nerves from a single spinal root. These lesions may be misdiagnosed as shingles (herpes zoster) due to their similar appearance and distribution. Unlike shingles, however, zosteriform metastases are usually not painful or associated with blistering. They may appear as clustered papules or plaques and can progress over time, becoming firmer and more extensive.3. Sclerodermoid lesionsAnother uncommon but significant skin manifestation of prostate cancer metastasis is sclerodermoid lesions. These present as hard, thickened, and sometimes shiny patches of skin that closely resemble scleroderma, an autoimmune condition that causes fibrosis and tightening of the skin. According to a study published in the Indian Journal of Dermatology, Venerology, and Leprology, the affected skin may feel bound down to the underlying tissue, limiting mobility and flexibility in the area. Such lesions are often mistaken for dermatological conditions such as morphea or lichen sclerosus, delaying the correct diagnosis.4. Ulcerated lesionsAlthough less common, ulcerated lesions may develop as a result of cutaneous prostate cancer metastases. These lesions occur when the cancerous nodules break through the skin’s surface, leaving open, raw sores that may ooze fluid or bleed. Ulcerated lesions are typically painful and difficult to manage, as they are prone to bacterial infections and have a slow-healing process. Their appearance usually signifies advanced or terminal disease, and they can severely impact a patient’s comfort and quality of life.
Diagnosis and differentiation from other skin conditions
A study published in PMC shows that diagnosing cutaneous metastasis from prostate cancer requires a thorough clinical evaluation and histopathological examination. Skin lesions that resemble other conditions, such as cellulitis, sebaceous cysts, or herpes zoster, can complicate the diagnosis.A biopsy of the skin lesion is essential for definitive diagnosis. Histological analysis can reveal the presence of prostate-specific antigen (PSA) and prostatic acid phosphatase, markers indicative of prostate cancer cells. Immunohistochemical staining is often employed to confirm the diagnosis.Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any changes to your health routine or treatment.Also read | What causes excessive sweating on face and head: Understanding craniofacial hyperhidrosis
