Skin metastases in patients with metastatic cancer have an overall incidence varying from of 0.7 to10%. They can occur as a first sign of the disease in 34% and 6% of the cases in man and woman respectively. The clinical features of skin metastases are frequently nodular, ulcerative and sclerodermoid. Rarely they can be inflammatory, vescicular or bullous, teleangectatic and zosteriform. Approximately 4.4% of cutaneous metastases occur as inflammatory or erysipelatoides carcinoma.

A 70-year-old woman affected by metastatic mammary carcinoma came to our consultation. She had recently developed cutaneous inflammatory metastases on the mastectomy scar and skull bone metastases. Radioterapy was previously performed only on the chest. Two weeks erlier she deloped erythemato-violaceous skin lesions on the scalp with tendency to ulcerate and subsequently crusting and superinfection (Fig1).

Breast cancer commonly involve the skin, so it represents almost 3/4 of female patients with cutaneous metastatic disease. Breast cancer is the most common tumor presenting as inflammatory metastatic disease. Metastatic spreading is via hematogenous, lymphatic, perineural diffusion or direct implantation. When lymphatic obstruction with vessel dilatation is remarkable violaceous cystic-liyke lesions of the skin can be observed giving a pseudo Stewart-Treves syndrome appearance. Stewart-Treves syndrome is a lymphangiosarcoma arising on the arms with chronic lymphedema of elderly females who have undergone mastectomy with axillary lyph node dissection or radiotherapy. Such an unusual presentation of breast cutaneous metastases to the scalp might have been the result of direct lymphatic spread of the tumor from the skull to the adjacent skin.

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