A case of cutaneous metastases in a 57-year-old female with cervical adenocarcinoma

Cervical cancer remains one of the leading gynecologic malignancies, ranking as the fourth most common cancer among women worldwide. In the Philippines, it is the second most frequent cancer among women overall and among those aged 15–44 years. Approximately 2.9% of women in the general population are estimated to have cervical HPV-16/18 infections at any given time, and 58.6% of invasive cervical cancers are linked to high-risk HPV types 16 or 18. Cutaneous metastases occur in 0.7–0.9% of cancer patients and result from the spread of a distant primary tumor to the skin. These lesions may present as the initial sign of metastatic disease or indicate cancer recurrence long after treatment of the primary tumor. In women, breast cancer is the most common primary tumor to metastasize to the skin, followed by colon cancer and melanoma. For cervical cancer, common distant metastatic sites include the lung, liver, bone, and brain. Cutaneous metastases from cervical cancer are extremely rare, with a reported incidence of 0.1–2%, and are generally associated with poor prognosis and frequent local or regional recurrence.

We present a case of a 57-year-old Filipino female with cervical adenocarcinoma who presented with cutaneous metastases, an uncommon clinical presentation for this malignancy. The patient developed pruritic, painful erythematous papules on the back, abdomen, extremities, and face, three weeks after her last brachytherapy session for stage 1B2 cervical adenocarcinoma. She also experienced intermittent fever (Tmax 39°C), non-productive cough, body weakness, and unintentional weight loss. Prior management included chemotherapy with cisplatin for six cycles, pelvic external beam radiotherapy, brachytherapy, and surgical management of a right ovarian growth.

Dermatologic examination revealed multiple well-defined, round erythematous nodules, some with minimal scaling and areas of erosion. A 4 mm punch biopsy showed atypical cells with hyperchromatic pleomorphic nuclei in the mid to lower dermis, lymphohistiocytic infiltrates, atypical mitoses, perivascular clustering, and “Indian filing.” Immunohistochemistry was positive for CK7, P16, and CEA, and negative for P63 and CK20, confirming cutaneous metastasis originating from the cervix.

This case highlights the rarity of cutaneous metastases in cervical adenocarcinoma and the importance of recognizing their variable clinical presentations, including nodules, plaques, and inflammatory lesions. Early detection and accurate diagnosis are critical for timely multidisciplinary management and prognostic evaluation. Reporting such cases contributes to the limited literature on this uncommon manifestation and provides valuable insights for dermatologists and oncologists managing similar patients.

Keywords: cutaneous metastasis, cervical cancer, cervical adenocarcinoma, dermatology, metastatic skin lesions