Lymphangitic carcinomatosis of colon carcinoma: a sign of poor prognosis

Conflict of interest: none declared. Skin metastases of colorectal cancer, especially lymphangitic carcinomatosis, are very uncommon. They can occur as the first sign of the tumour, as so‐called precocious metastases, but can also be an early indicator of metastatic disease, usually with a fatal prognosis. We report an extremely rare case of lymphangitic carcinomatosis occurring in a patient with adenocarcinoma of the colon, who also had a mutation in the KRAS gene. A 63‐year‐old woman presented with a 3‐month‐history of painful and burning skin lesions on her left abdomen. Twenty years previously, she had been diagnosed with a benign tubulovillous adenoma of the colon, and 3 years previously with an adenocarcinoma of the colon. At the latter time, she had undergone resection of the transverse colon (pT4pN2G3) and received six cycles of palliative chemotherapy (bevacizumab initially, then oxiplatin and capecitabine from the second cycle), followed by 13 cycles of palliative therapy with capecitabine, then eight cycles of camptothecin, and finally, three cycles of palliative chemotherapy with oxiplatin, capecitabine and bevacizumab. The skin eruptions occurred at that time, and there was further tumour progression with an increase in carcinoembryonic antigen to 51 μg/L (normal range 1.5–5 0 μg/L).