Late recurrence of large peri-stomal metastasis following abdomino-perineal resection of rectal cancer

This is a case description of the management of a large fungating peristomal cutaneous metastasis occurring 14 years after abdomino-perineal excision of the primary cancer. The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread. But histopathology of the resected specimen showed no colonic mucosal involvement suggesting a true large cutaneous peristomal metastasis which has not been reported previously. Literature review of presentation, management and prognosis of cutaneous metastasis from colorectal cancer is describedCutaneous metastasis following colorectal cancer resection is a well-recognised entity though rare. Any unusual skin lesions especially on the abdominal wall skin, previous incision scars or near the stoma should be biopsied early to rule out metastatic disease and systematic work-up should be carried out to rule out any metachronous tumour or metastasis elsewhere in the body.Cutaneous metastasis arising from colorectal malignancy is a rare occurrence though well reported in literature. It is a pointer to more widespread disease and usually indicates a poor prognosis. Cutaneous metastasis can be the presenting feature before the primary is diagnosed e.g. Sister Mary Joseph's nodules. They can also occur late after the primary has been completely excised and can present either as cutaneous rash or as subcutaneous nodules in proximity to previous operative scars (abdominal or perineal) or on the abdominal wall skin. This is an unusual presentation of a large fungating peristomal metastasis without any visceral involvement following abdomino-perineal excision of a large T4 rectal cancer done 14 years earlier.A 61 year old lady was referred by the General Practitioner as an emergency with a rapidly enlarging fungating mass around her end-colostomy site. She had undergone an abdomino-perineal resection 14 years earlier for a Duke's B rectal cancer. She had initially presented 14 years ago with features of