Multiple cutaneous nodules as the presenting sign of small cell lung cancer

We describe a 67-year-old male smoker who presented with an 8 week history of productive cough, dyspnoea on minimal exertion, weight loss of 8 kg and multiple painful cutaneous nodules of varying size and morphology. A chest radiograph showed a mass at the right hilum. A CT examination showed extensive mediastinal lymphadenopathy with encasement of the lower trachea, carina and left main bronchus. The left main bronchus was 95% stenosed and there were multiple liver metastases. Innumerable cutaneous nodules were also seen. A biopsy of one of the cutaneous nodules confirmed metastases from a neuroendocrine lung primary tumour, consistent with extensive stage small cell lung cancer. The patient died soon after diagnosis.