Since the first recorded case of cutaneous metastases of TCC of the urinary bladder in 1909 [
8], infrequent reports have reached the world literature. Skin metastases may occur at any time after the initial diagnosis at the primary site [
9]. From the published literature, cutaneous metastases most often occur within 18 months of the primary diagnosis, and only one documented case occurring 10 years after the primary diagnosis [
10]. The incidence of metastatic TCC of the bladder is directly related to depth of penetration of the bladder wall, tumor grade and tumor size, with depth of tumor penetration being the single most important factor in predicting prognosis in TCC [
11,
12]. However, metastases may be associated with superficially invasive primary disease [
13,
14]. Urologic malignancies most commonly metastasize to regional lymph nodes, liver, lung and bones [
5,
15]. Metastatic infiltration of the skin or subcutaneous tissues can occur due to direct tumor invasion, hematogenous or lymphatic spread, or as a result of iatrogenic implantation of tumor cells [
5]. Gross appearance of cutaneous metastases is not distinctive and may mimic many common dermatologic disorders [
16,
17]. These lesions can be solitary or multiple in appearance [
14,
15,
18]. Brownstein
et al. described three clinical features of metastatic cutaneous lesions, including a nodular type, inflammatory type, and sclerodermoid type [
19]. In addition, a rarer zosteriform lesion has also been documented [
20-
22]. Metastatic skin lesions from genitourinary TCC are reported to be always located on the head, face, neck, trunk, abdomen, suprapubic region or extremities, as well as occasionally on scrotal skin and the ocular region [
9].
Diagnosis requires clinical suspicion of metastases as well as histological evaluation. Diagnosis is usually established by microscopic examination of excisional biopsy specimens [
9]. Among reported cases, cutaneous metastases of TCC almost exclusively show high-grade differentiation of histological grading at the primary genitourinary sites [
9]. Wang
et al. discovered that coordinated expression of cytokeratins 7 and 20 are positive in 89% of transitional cell bladder cancer [
23].
The prognosis for patients with cutaneous TCC is typically poor, with a median survival of fewer than 12 months [
17]. However, very rare cases of extended survival (up to 23 years) have been reported [
24]. The treatment of choice for metastatic bladder cancer is either chemotherapy, with the combination of gemcitabine and cisplatin or the methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) scheme; or palliative care [
25]. Chemotherapy has reported tumor remission rates up to 70% [
25], but survival does not exceed 14 months [
3]. Symptomatic patients may benefit from surgical resection of metastases in terms of tumor-related symptoms and performance status [
26]. Local radiation therapy has also been reported to resolve cutaneous lesions, which did not respond to chemotherapy [
17].