Erythematous nodules of the hand: A rare site of metastatic breast carcinoma

Acral cutaneous metastasis is a rare phenomenon. A 38-year-old woman presented with painful lesions in the left hand since 1 month. On examination, multiple painful, erythematous, lobulated plaques and nodules were present over the palmar aspect of the finger tips and thenar eminence. Biopsy of the nodule revealed lobules of small pleomorphic epithelial cells arranged in singles, small nests, cords and small abortive luminal pattern in an abundant mucoid matrix, suggestive of metastatic mucinous carcinoma. Past history revealed that the patient had undergone bilateral mastectomy for carcinoma breast. Diagnosis of cutaneous metastases is based on clinical history and histopathological examination. Identification of the primary tumor is very important for prompt treatment and prognosis. The rarity of pure acral cutaneous metastasis and its possible pathogenetic mechanisms are discussed.