Epidermotropically metastatic breast carcinomas: Rare histopathologic variants mimicking melanoma and Paget's disease

Luis Requena, Evaristo Sánchez Yus, Cristina Núñez, Clifton R. White, Omar P. Sangueza

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Epidermotropic metastases from internal malignancies are exceedingly rare. We report two examples of epidermotropic metastatic breast carcinoma with striking intraepidermal involvement. The first case mimicked melanoma because the neoplastic cells contained melanin and were disposed both as single units and as nests at the dermoepidermal junction and throughout the epidermis. In the second case, the neoplastic cells were seen as isolated neoplastic cells with large, pale cytoplasm scattered throughout the epidermis, closely resembling extramammary Paget's disease. Immunohistochemical studies in both cases demonstrated the epithelial nature of intraepidermal neoplastic cells, which showed an immunophenotype identical to the neoplastic cells present in the dermis: positive staining with anti- cytokeratins, CEA, EMA, and GCDFP-15 and negative with anti-S-100 protein and HMB-45. These findings ruled out the possibility of a collision lesion, or simultaneous occurrence of melanoma and metastatic breast carcinoma. Pagetoid intraepidermal spread of metastatic breast carcinoma, as in our two cases, is exceptional. We also discuss the histogenetic similarities between our findings and those of mammary and extramammary Paget's disease, as well as the differential diagnosis of other cutaneous disorders characterized by pagetoid intraepidermal spread of neoplastic cells.

Original languageEnglish (US)
Pages (from-to)385-395
Number of pages11
JournalAmerican Journal of Dermatopathology
Issue number4
StatePublished - 1996
Externally publishedYes


  • Breast carcinoma
  • Cutaneous metastases
  • Epidermotropism
  • Melanoma
  • Paget's disease

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Dermatology


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