治療與預後（TREATMENT AND PROGNOSIS）
典型上，皮膚轉移是晚期或進行性疾病的先兆，因而預示不良預後。皮膚轉移初次診斷後的平均存活時間為 7.5 個月，且半數病人於最初 6 個月內死亡。無論病人的原發惡性腫瘤是已知或未知，皮膚轉移的發生都需要多專科取徑，包括內科與外科腫瘤醫師、放射腫瘤醫師，以及在適當時的心理健康照護提供者。皮膚轉移的局部治療可基於功能性、緩和性或美觀上的適應症而施行。在可行時執行手術切除；然而，放射治療與局部化學治療藥物或免疫治療可依個案考量。全身性療法適用於對免疫治療或化學治療有反應的腫瘤。當有惡臭時，可將外用 metronidazole 溶液（以靜脈注射用製劑提供）以棉紗布或噴瓶每日塗抹一至二次，或將壓碎的 metronidazole 錠劑每日兩次灑於腫瘤上。
Additional figures available in our eBook (see inside front cover for access code).
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某些器官限定性的標記也可能有用，包括：CD10、RCC 與 PAX8（在腎臟與卵巢腫瘤中呈陽性）；thyroid-specific transcription factor-1（TTF-1）（甲狀腺、肺；見 Fig. 122.2）；thyroglobulin（甲狀腺）；prostate specific antigen（PSA）與 NKX3.1（攝護腺）；CDX2、CDH17 與 SATB2（腸胃道）；Hep Par1 與 arginase-1（肝細胞癌）；以及 CD56 與 insulinoma-associated protein 1（INSM1）（神經內分泌）（見 Table 122.4）。在 SCC 的皮膚轉移中，pankeratins 與 EMA 的染色可能呈陽性，但此資訊對判定原發 SCC 的部位並無幫助。
除了對傳統皮膚切片進行組織學檢查之外，皮膚轉移亦可經由細針抽吸細胞學（fine-needle aspiration cytology）取樣。
圖 122-2：小細胞肺癌的皮下轉移。A 注意真皮的倖免。B 高倍放大顯示基底樣細胞的群集。C 腫瘤細胞對 CK7 染色呈陽性。D 腫瘤細胞亦對 TTF-1（thyroid transcription factor-1）染色呈陽性
Fig. 122.2 Subcutaneous metastasis of small cell lung carcinoma.A Note sparing of the dermis. B Higher magnification demonstrating clusters of basaloid cells. C The tumor cells stain positively for CK7. D The tumor cells also stain positively for TTF-1 (thyroid transcription factor-1). Courtesy Lorenzo Cerroni, MD.
表 122-4：皮膚轉移的病理所見
Table 122.4 Pathologic findings in cutaneous metastases. p40/p63 negativity favors metastases, but it may be negative in some cutaneous adnexal carcinomas, particularly mucinous eccrine carcinoma. CA, carcinoma; CDH17, cadherin 17; CDX2, homeobox protein CDX2; CEA, carcinoembryonic antigen; CK, cytokeratin; EMA, epithelial membrane antigen; ER, estrogen receptor; GATA3, a transcription factor that regulates mammary epithelial differentiation; INSM1, insulinoma-associated protein 1; MITF, microphthalmia transcription factor; MNF116, pankeratin marker; NKX3.1, NK3 homeobox 1; PAX8, paired box 8; PR, progesterone receptor; PSA, prostate-specific antigen; PSAP, prostatic-specific acid phosphatase; RCC-Ma, renal cell carcinoma marker – detects a renal tubule antigen (highly specific); SATB2, special AT-rich sequence-binding protein 2/SATB homeobox 2; SCC, squamous cell carcinoma; SOX-10, SRY-box transcription factor 10; TTF-1, thyroid transcription factor 1; WT-1, product of Wilms tumor gene.