An unusual presentation of metastatic disease: Cutaneous metastases from pulmonary adenocarcinoma manifesting as widespread plaques

Fig 1. Computed tomography scan of the thorax: malignant pleural effusion, involvement of the pectoralis major muscle and sternocleidomastoid muscle, and a 1.83 1.4cm subcutaneous nodule in the right subareolar region. CASE REPORT A 63-year-old man with stage IV pulmonary adenocarcinoma presented with shortness of breath, weakness, and a 3-month history of a rash on his right chest. Prior positron emission/computed tomography scan demonstrated hilar, mediastinal, neck, and axillary adenopathy along with brain metastasis. He had received whole brain radiation and 6 cycles of carboplatin and pemetrexed. He recently had 2 episodes of pneumonia, and 10 days before this presentation, he had been found to have a pulmonary embolism and rivaroxaban was started. On admission, a chest x-ray revealed a right-sided pleural effusion. A computed tomography scan showed a stable right upper lung mass, progressive metastatic disease, a growing malignant pleural effusion, and muscular and subcutaneous involvement. Involvement of the pectoralis major muscle and sternocleidomastoid muscle along with a 1.83 1.4-cm subcutaneous nodule in the right subareolar region was seen (Fig 1). A right axillary node biopsy specimen demonstrated poorly differentiated carcinoma, which was