Erysipelas carcinomatosum C80.x2

Lymphangiosis carcinomatosa; lung carcinoma; adenocarcinoma; lymphedema of the arm; breast carcinoma; 

Widespread infiltration of the skin with tumor cells due to metastasis, primarily via the lymphatic vessels of the lower dermis and subcutaneous tissue (lymphangiosis carcinomatosa). Occurs primarily in breast cancer. Less commonly seen in cancers of the pancreas, stomach, lung, rectum, and ovary. May progress tocancer en cuirasse. See also:skin metastasis. Similar clinical presentations may also occur with locoregional metastasis of malignant melanoma (erysipelas melanomatosum).

Sharply and jagged-edged, fiery red, hyperthermic, possibly tender to pressure, pasty and edematous, usually very thick plaques of varying sizes (typically 2–50 cm, less commonly encircling an entire body part) that are densely or sparsely covered with telangiectasias. The edges are often elevated. The surface often exhibits an “orange peel” appearance. Differential diagnostic difficulties (distinguishing it from erysipelas) may arise when an inflammatory metastasis develops within an old mastectomy scar with chronic radiodermatitis.  

Tumour cell invasion with dilatation especially of the deep dermal and subcutaneous lymph vessels, hyperemia, oedema, perivascular round cell infiltrate.

Erysipelas, radiodermatitis, mastitis.

The aim of treatment is to maintain the best possible quality of life despite an unfavorable prognosis. Individual skin metastases can be excised. Radiotherapy or cytostasis are possible for extensive metastases. The treatment regimen depends on the spread of the metastases and the primary tumor.

Seriously, 1/3 of patients already have distant metastases at the time of manifestation .

A female patient in her mid-70s with a known history of lung adenocarcinoma (T4N3M0) that had been treated with pembrolizumab. Three months prior to the findings shown in the images, the patient noticed lymphedema of the right arm as well as palpable axillary and cervical lymph nodes. The skin lesions were painless but continued to spread (over a period of months). At this advanced stage, extensive, map-like, reddish-livid, well-defined, firm plaques were observed. A biopsy revealed the presence of carcinoma clusters in the lymphatic spaces of the cutis (see “Figures” under “Case Reports”: Kerkhoff L / 2026).     

1. Hariry H et al. (2000) Erysipelas carcinomatosum in tubular adenocarcinoma of the stomach. Hautarzt 51: 950-952
2. Kerkhoff L (2026) Lymphangiosis carcinomatosa of the skin in lung carcinoma. Dt Ärzteblatt 123: 280
3. Krumbholz A et al. (2006) Erythematous swelling of the left arm in a 70-year-old woman. Erysipelas carcinomatosum in breast carcinoma. J Dtsch Dermatol Ges 4:69–71
4. Lindmaier A et al. (1990) Two cases of melanomatous erysipelas—differential diagnosis and terminology. Hautarzt 41:628–632