Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(2):e2024067 1 Cutaneous Metastases as a First Sign of Gastric Adenocarcinoma Marta Prtajin1, Daniela Ledić Drvar1, Daška Štulhofer Buzina1, Ružica Jurakić Tončić1, Ivana Ilić2, Romana Čeović1 1 Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia 2 Department of Pathology and Cytology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia Citation: Prtajin M, Ledić Drvar D, Štulhofer Buzina D, Jurakić Tončić R, Ilić I, Čeović R. Cutaneous Metastases as a First Sign of Gastric Adenocarcinoma. Dermatol Pract Concept. 2024;14(2):e2024067. DOI: https://doi.org/10.5826/dpc.1402a67 Accepted: October 23, 2023; Published: April 2024 Copyright: ©2024 Prtajin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/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: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Professor Romana Čeović, MD PhD, Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb Kišpatićeva 12, 10000 Zagreb, Croatia. E-mail: romana.ceovic@gmail.com Case Presentation A 61-year-old female patient was referred to our depart- ment with newly developed erythematous nodules on the skin of the back of her neck (Figure 1A). Concurrently, she reported unintentional weight loss, faster intestine transit time, and painful gastric spasms. She had no se- vere diseases history. After a year of extensive diagnos- tic procedures, she was diagnosed with diffuse gastric adenocarcinoma. Histopathological examination of her skin biopsy revealed cutaneous metastasis, which was confirmed with cytokeratin (CK)-7 immunohistochemical positivity ( Figure 1B). Over the following year and a half, our patient underwent surgery, followed by several chemotherapy cycles. Multiple cutaneous metastases on her trunk were treated with radiotherapy, resulting in se- vere post-irradiation reaction. Unfortunately, despite all treatment, she passed away. Teaching Point Cutaneous metastasis may be the first sign of a silent primary tumor [1]. Metastatic dissemination to the skin occurs by lymphatic or hematogenous spread, direct contiguity, peri- cytic mimicry, or iatrogenic implantation. Metastases may appear before primary tumor identification in approximately 10% and simultaneously in 25.1% cases, but generally later in the disease course [2]. Lung cancer is accountable for most cases in men and breast cancer in women. Cutaneous metas- tases mostly present as nodules [1,2]. Some gastrointestinal tumors may give metastases to the umbilicus, presenting as Sister Mary Joseph nodule [1]. Clinical morphology, loca- tion, and histopathological and immunohistochemical find- ings of cutaneous metastases alongside patient’s sex and age are essential for diagnosing primary neoplasm [2]. Derma- tologists have an important role in early recognition and dif- ferentiation of correct diagnosis [1]. 2 Image Letter | Dermatol Pract Concept. 2024;14(2):e2024067 References 1. Ledić Drvar D, Pašić A, Manola I, Radoš J, Dobrić I, Lončarić D. A Eleven-Year Retrospective Study of Metastatic Carcinomas of the Skin: Own Experience.  Acta Dermatovenerol Croat. 2005;13(3):160-167. PMID: 16146618. 2. Sittart JA, Senise M. Cutaneous metastasis from internal carcino- mas: a review of 45 years. An Bras Dermatol. 2013;88(4):541-544. DOI: 10.1590/abd1806-4841.20131165. PMID: 24068124. Figure 1. (A) Clinical presentation. (B) Positive immunohistochemical staining for CK-7.