\[Cutaneous metastasis of pleural mesothelioma\]

Our plain-English summary of [Cutaneous metastasis of pleural mesothelioma], by A. Aliu, K. Hohaus, U.P. Wehry, et al (Die Dermatologie, 2026).

The study

• Authors: A. Aliu, K. Hohaus, U.P. Wehry, Z. Deeb, F. Oellig, T. Gambichler, S.N. Burmann, A. Kreuter
• Journal: Die Dermatologie
• Published: 2026;77(2):131-135
• Type of article: Case report
• Language: German
• Read it: PubMed · Publisher · Free full text

Abstract

Cutaneous metastasis of pleural mesothelioma is a rare manifestation and poses a diagnostic challenge due to its histopathological heterogeneity. We present a clinical case in which cutaneous metastasis of a known pleural mesothelioma was initially misdiagnosed. The correct diagnosis of cutaneous metastasis of a pleural mesothelioma was only confirmed through detailed immunohistochemical analysis. Precise histological classification is of high clinical relevance, as the therapeutic approach particularly depends on the histological subtype and the patient's Eastern Cooperative Oncology Group (ECOG) performance status. Early and accurate diagnosis, as well as timely initiation of appropriate therapy, are prognostically important.

© 2025. The Author(s).

In plain English

This German case report described an 85-year-old patient seen at a dermatology clinic with a skin tumor at the angle of the right jaw that had grown quickly over a few months. Two years earlier, the patient had been diagnosed with inoperable left-sided pleural mesothelioma and treated with palliative chemotherapy, which had later been paused. An outside biopsy of the skin tumor had been read as squamous cell carcinoma, a type of skin cancer, without immunohistochemical testing (staining for marker proteins). After the clinic removed the roughly 25 mm nodule, the staining was positive for calretinin, WT1, CK5/6, D2-40 and AE1/AE3 and negative for S100, Melan A and p40. The diagnosis was then revised to a skin metastasis of malignant pleural mesothelioma, stage IVB. Scans found no other distant spread, and the tumor board decided to restart pemetrexed alone and include the patient in palliative-supportive care. The authors concluded that skin metastases should be considered when new skin changes appear in patients with pleural mesothelioma. The article did not describe the patient's asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient) with discussion of the literature
• Who was studied: One 85-year-old patient seen at the dermatology clinic of Helios St. Elisabeth Krankenhaus Oberhausen, Germany, with a skin tumor at the right jaw angle and a pleural mesothelioma diagnosed two years earlier
• Exposure: The article does not report this patient's asbestos exposure or occupation
• Main results:
  • Two years before the skin tumor, the patient was diagnosed with left-sided, inoperable pleural mesothelioma (clinical stage cT4, cN0, cM0, stage IIIB)
  • The patient received palliative chemotherapy with cisplatin and pemetrexed. Because of chronic kidney failure this was switched to pemetrexed alone, which was stopped because of pancytopenia requiring transfusions. A treatment pause was then agreed with the patient.
  • The skin lesion was a roughly 25 mm, stalked, red, eroded, bleeding nodule on the right lower jaw that had grown rapidly over a few months
  • An outside biopsy had diagnosed an acantholytic, moderately differentiated squamous cell carcinoma, without immunohistochemical tests
  • After excision, the tumor cells showed focal calretinin and homogeneous nuclear WT1 expression and were positive for CK5/6, D2-40 and AE1/AE3. They did not express S100, Melan A or p40.
  • The diagnosis was revised to a skin metastasis of malignant pleural mesothelioma, classified as cT4 cN0 pM1, stage IVB
  • Staging by CT from neck to pelvis and cranial MRI showed no sign of further distant metastasis. The tumor board decided to restart pemetrexed alone and include the patient in palliative-supportive care.
  • The patient had not had radiation to the primary tumor or the affected skin area, so the finding was not interpreted as a metastasis at a previously irradiated site
• The authors' conclusion: The authors concluded that cutaneous metastases should be considered as a possible diagnosis when new skin changes appear in patients with pleural mesothelioma, because correctly identifying them can substantially affect treatment. They noted the International Mesothelioma Interest Group recommendation of a panel of at least 2 mesothelial and 2 carcinoma-specific markers.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Histological Subtype, Performance Status.

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