Cutaneous metastasis of unusual cause.

Squamous esophageal carcinoma (SEC) is a frequent disease in adults, and dysphagia is usually the initial symptom [1]. Esophageal carcinoma that metastasizes to the skin is unusual [2]. We report a case of SEC whose first manifestation was a right breast cutaneous metastasis without local symptoms or bone metastasis. A 51-year-old man with a history of chronic alcoholism was admitted to the hospital for an altered level of consciousness of about 24-h duration. Physical examination revealed a man who was awake and alert but confused. He was afebrile. He had peripheral lymphadenopathies and a 1.5-cm nodular lesion in his right breast. Laboratory investigations revealed the following: white blood cell count 16,900/μl (81 neutrophils), erythrocyte sedimentation rate 101 mm/h, calcium 18 mEq/dl (normal range 8.8–10.5) and phosphorus 2.7 mEq/dl (normal range 2.2–4.4). Parathyroid hormone concentration was below 1.20 pg/ml (normal range 10–65). Serum protein electrophoresis was negative for multiple myeloma. The patient received intravenous saline hydration, prednisone 1 mg/kg/day, calcitonin 200 UI/12 h, furosemide 20 mg/8 h and biphosphonates 4 mg/kg/day. A thoracic abdominal computed axial tomography scan (CT scan) and percutaneous fine needle aspiration of the nodular lesion