Skin Metastasis From Malignant Neoplasms-Reply

In Reply.—  Dr Hussey correctly points out that the vertebral venous system described by Batson^1,2 is an important route of spread of metastases. Its presence may well explain the predilection for metastases from carcinoma of the breast, prostate, and rectum, as well as other pelvic malignant neoplasms, for the axial skeleton.However, as we pointed out in our article, in our patient we believed that the histopathologic appearance of plugging of lymphatic and vascular channels in the upper and middle dermis with tumor cells, in the presence of extensive disease in the pelvis and bilateral inguinal lymphadenopathy, was more consistent with retrograde spread of tumor cells as a result of lymphatic obstruction.