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To the Editor.—
The August 1981 Archives (117:513-515) contains a report by Schwartz and Fleishman in which a large transitional cell carcinoma appeared in the inguinal region of an 83-year-old woman. The skin lesion was discovered incidentally to represent a metastasis from the distal part of the urethra. The authors proposed that the metastatic lesion resulted from extension via lymphatic vessels to the inguinal lymph nodes.Although the authors' speculation about the mode of metastasis is plausible, they do not mention enlargement of inguinal lymph nodes or that a lymph node specimen was examined microscopically.Another possible explanation for the metastatic route would incriminate the vertebral venous system, which explains many otherwise inexplicable metastatic skin and other lesions.1-3 The system is especially rich in the pelvic region and accounts for the osseous metastases from prostatic cancer.
Hussey HH. Skin Metastasis From Malignant Neoplasms. Arch Dermatol. 1982;118(5):289. doi:10.1001/archderm.1982.01650170003002