This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
We appreciate Dr Hussey's interest in our article on a histologically specific transitional cell metastasis to the skin from a primary tumor of the urinary tract. Whether this cutaneous metastasis resulted from direction extension from an underlying regional lymph node or by direct hematogenous spread remains unclear. The underlying lymph nodes were never examined microscopically, and the patient has not, to our knowledge, died.We certainly agree with Dr Hussey that the vertebral venous system may have accounted for the clinical lesion. We consider hematogenous spread, including spread through the vertebral venous system, a reasonable possibility. Clearly, the clinical experiments of Batson,1 demonstrating the vertebral venous system, are worth recalling. That is, metastases may spread through this valveless system of veins, which may not lead through the lungs, to produce what might otherwise be considered unusual metastatic spread. For example, injection of dye into the deep dorsal
Schwartz RA, Fleishman JS. Skin Metastasis From Malignant Neoplasms-Reply. Arch Dermatol. 1982;118(5):289-290. doi:10.1001/archderm.1982.01650170003003