Dermatology: Practical and Conceptual Dermatology Practical & Conceptual Image Letter | Dermatol Pract Concept. 2021;11(3): e2021061 1 Cutaneous Metastasis Presenting as Vesicular-Like Lesions Ravikumar Mudugal1, Anupama Bains1, Anil Budania1, Meenakshi Rao2 1 Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 2 Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Key words: Cutaneous metastasis, vesicular-like Citation: Mudugal R, Bains A, Budania A, Rao M. Cutaneous metastasis presenting as vesicular-like lesions. Dermatol Pract Concept. 2021;11(3): e2021061. DOI: https://doi.org/10.5826/dpc.1103a61 Accepted: December 1, 2020; Published: July 8, 2021 Copyright: ©2021 Mudugal et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. Authorship: All authors have contributed significantly to this publication. Corresponding author: Anupama Bains, Dermatology OPD, OPD Building, AIIMS Jodhpur, Basni Phase 2, Jodhpur, Rajasthan, India. Email: whiteangel2387@gmail.com. Case Presentation A 76-year-old man presented with vesicular-like lesions covering the submandibular area and the sides of the neck (Figure 1). The patient was a known case of squamous cell carcinoma affecting the floor of the mouth. Histopathology of the lesions showed a tumor in the dermis with squamoid mor- phology, polygonal cells, abundant eosinophilic cytoplasm, and vesicular nucleus (Figure 2). On immunohistochemistry, cells were positive for p63 and p40 markers. Final diagnosis of cutaneous metastasis, secondary to squamous cell carci- noma, was made. Teaching Point Cutaneous metastases generally present as solitary or multiple hard nodules. Other atypical presentations such as mor- phea-like, erysipelas-like, alopecia neoplastica, zosteriform metastases, etc., are rarely seen [1]. Vesicobullous metastasis is rare and has been previously described in breast cancers and melanomas. In our case, because of the vesicular-like lesions, Figure 1. Multiples vesicular-like lesions over the anterior and lat- eral side of the neck. the disease mimicked disseminated herpes zoster, radiother- apy induced bullous pemphigoid, hence awareness regarding such presentation is important. 2 Image Letter | Dermatol Pract Concept. 2021;11(3): e2021061 References 1. Mordenti C, Peris K, Fargnoli MC, Cerroni L, Chimenti S. Cuta- neous metastatic breast carcinoma: A study of 164 patients. Acta Dermatovenerol 2000;9:143-8. Figure 2. Histopathological examination (H&E, x40) showed tu- mor in dermis with squamoid morphology, polygonal cells, abun- dant eosinophilic cytoplasm, and vesicular nucleus.