An Unusual Manifestation of the Carcinoid Syndrome

CUTANEOUS manifestations of the carcinoid syndrome commonly include transient flushing of the face and upper trunk, patchy cyanosis, and telangiectasia.1There have been occasional reports of severe pruritus, "orange blotches,"2pellagra-like dermatitis,3acropachyderma, pachyperiostitis,4and sclerodermatous changes.5The occurrence of cutaneous metastatic nodules is infrequent.4,6-9After recent observation of a patient with the carcinoid syndrome with nodular cutaneous metastases as well as two unusual necrotic areas involving the skin, we reviewed the literature and were unable to find a report concerned with the latter lesions. Case Report A 62-year-old white man was first admitted to the University of Minnesota Hospitals in March 1967 with a diagnosis of carcinoid syndrome which had been confirmed elsewhere by abdominal exploration. Because of hepatic metastasis in the right lobe of the liver, it was removed in April 1965. A metastatic lesion in the mediastinum was removed in