Cutaneous metastases are generally associated with carcinomas invading the bladder musculature(T3a) or to a local advanced neoplasm (T3b/T4), although the literature reports a few cases of cutaneous metastasis in early stage bladder cancer [
3]. Presence of cutaneous localization from urinary bladder cancer is highly correlated to large metastatic disease [
4]. Prognosis after cutaneous metastasis appear generally poor with a median survival of 13 to 14 monthsfor patients treated by chemotherapy, although there is one sporadic case in the literature reporting survival at 34 months [
5,
6]. Wide surgical excision, as a curative and diagnostic attempt, is considered the first line procedure in these patients. In the treatment of metastatic bladder cancer, single agent chemotherapy using methotrexate, doxorubicin, vinblastine or cisplatin produce response rates in 15 to 25% of patients, whilst multiple agent chemotherapy treatment increases this to 50 to 70% of cases[
7]. The combination of gemcytabin, paclitaxel and cisplatin produce response rates in 78% of cases and a complete remission in 28% of the patients producing a median survival rate of 24 months [
8]. Alternative combinations of adjuvant therapies are reported in the literature. Craig et al reports a successful case with complete clinical resolution of two metastatic skin lesions in a patient submitted to a cystoprostatectomy for bladder carcinoma, using local irradiation [
8]. Kubata et al also discuss a case of complete resolution in a patient treated with bleomycin electrochemotherapy. [
9]. Although we need to consider that a non-operative clinical plan in these patients leads to certain disease progression, a single case in the literature describes a case of cutaneous metastasis with spontaneous regression [
10]. However, this unusual subtype of cancer still remains a rare histological carcinoma variant where pathological diagnosis is often very difficult with a complex and extensive immunohistochemistry and genetic pattern as described by Terada in his recent publications [
11,
12].
The most prominent clinical characteristic of a sarcomatoid carcinoma of the urinary bladder is the extreme aggressive behavior. However, if the stage and the patient's clinical condition indicate surgery as appropriate, then the therapy of choice will be a radical surgical therapy. When surgery is not an option, palliation with radiotherapy is indicated. Further studies are necessary before we can make a conclusion on the therapeutic strategies for sarcomatoid carcinomas of the bladder.