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JAMA Oncology Clinical Challenge
July 2018

Pink Papules in a Patient With Salivary Duct Carcinoma

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Dana Farber Cancer Institute, Boston, Massachusetts
JAMA Oncol. 2018;4(7):991-992. doi:10.1001/jamaoncol.2017.4853

A 46-year-old man with salivary duct carcinoma of the right parotid gland presented for evaluation of a 3-week history of multiple new pruritic skin lesions on the right chest. The patient’s salivary duct carcinoma was androgen receptor positive and HER2 positive. He had previously undergone parotidectomy followed by radiation therapy and adjuvant chemotherapy with carboplatin, paclitaxel, and trastuzumab. He had continued with androgen-deprivation therapy and palliative radiation therapy for osseous metastases. The patient endorsed erythematous skin changes within the field of radiation and a 2-month history of painful right upper extremity lymphedema that began after his most recent radiation treatment. He denied fevers or other systemic symptoms associated with the onset of the skin lesions. Physical examination revealed numerous nontender, firm, pebblelike, pink papules on the right anterior neck, upper chest, and back, arising on a background of confluent blanchable violaceous erythema (Figure, A), as well as similar-appearing lesions on the right chest wall on a background of normal-appearing skin. Concurrent skin biopsies from the right chest wall, clavicular area, and upper right back were performed (Figure, B and C).

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