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American Society of Clinical Oncology, Journal of Clinical Oncology, 4_suppl(40), p. 615-615, 2022

DOI: 10.1200/jco.2022.40.4_suppl.615

Wiley Open Access, Cancer Medicine, 1(12), p. 179-188, 2022

DOI: 10.1002/cam4.4916

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Pancreatic cancer: Cutaneous metastases, clinical descriptors and outcomes

This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

615 Background: The occurrence of cutaneous metastasis from pancreatic cancer (PC) is rare, and the exact incidence is unknown. The literature to date is primarily limited to isolated case reports. Herein, we evaluate the clinical, genomic, and other descriptors of patients with PC and cutaneous metastases. Methods: Institutional databases were queried using search terms “pancreas cancer” and “cutaneous mets”. Clinical history, demographics, PC cutaneous metastasis details, and survival outcomes were abstracted. Results were described using descriptive statistics, and overall survival (OS) from the diagnosis of cutaneous metastasis was estimated using Kaplan-Meier methods. Results: Of 140 on initial search, 40 patients met inclusion criteria of PC and cutaneous metastases and were analyzed. The median age (Q1-Q3, IQR) of pancreatic cancer diagnosis was 66.0 (59.3-72.3, 12.9) years. Most common histologic subtype was adenocarcinoma (n= 39, 98%), and one patient had a neuroendocrine malignancy. Most patients had stage IV disease at diagnosis (n=26, 65%). The most common location of the primary tumor was tail of the pancreas (n=17, 43%). Forty-eight percent (n= 19) had cutaneous metastasis at/within one month of cancer diagnosis. Most patients received chemotherapy (n=37, 93%), with 14 patients (35%) patients also receiving local therapy in the form of local excision or radiation. The most common cutaneous metastasis site was the abdomen (n=40, 66%), with umbilical lesions occurring in 58% (n=23) of abdominal lesions. The median interval (Q1-Q3, IQR) between diagnosis of pancreatic cancer and development of cutaneous metastasis was 1.4 (0-14.5, 14.5) months. The median OS (95% CI) from cutaneous metastasis diagnosis was 11 months (7.0, 20). Table details the observed differences between umbilical vs. non-umbilical metastases. Sixteen of 40 (40%) patients underwent somatic testing. The most frequently mutated genes were KRAS (n= 16, 100%), TP53 (n=7, 44%), CDKN2Ap14ARF (n=5, 31%), CDKN2Ap16INK4A (n=5, 31%), and CDKN2B (n=3, 19%). Germline testing was undertaken in 12 (30%) patients, and pathogenic variants were observed in 3: CHEK2 (n=1, 8%), BRCA1 (n=1, 8%), and ATM (n= 1, 8%). Summary of cutaneous metastasis characteristics. Conclusions: Cutaneous metastases from PC are rare and can be present at the time of diagnosis of stage IV disease, occurring most frequently in the umbilicus. Cutaneous metastases can be classified into umbilical and non-umbilical metastases, which may be due to a different biology.[Table: see text]