Clown nose sign as a manifestation of pulmonary neoplasia




Ricardo F. Rojas-López, Servicio de Dermatología, Clínica FOSCAL Internacional, Floridablanca, Colombia
Jorge L. Bermúdez-Flórez, Servicio de Dermatología, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
Diana I. Conde-Hurtado, Servicio de Medicina, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
Óscar F. Valdivieso-Cárdenas, Servicio de Radiología, Radiólogos Especializados, Floridablanca, Colombia
Nathalia Garavito-Hernández, Servicio de Patología, Isabel Bolívar Laboratorio. Floridablanca, Colombia
Isabel C. Bolívar-Aguilera, Servicio de Patología, Isabel Bolívar Laboratorio. Floridablanca, Colombia


Introduction: Cutaneous metastases are sowings of malignant cells in the skin of distant tumors that should be suspected in rapidly growing lesions without response to treatment. They represent a clinical challenge because they do not have a specific macroscopic morphology, while histologically they are located in the dermis and hypodermis (they lack an in situ component). Case presentation: We describe the case of an older adult woman who has metastasis in Clown Nose after developing lung cancer with two different variants: adenocarcinoma and squamous cell carcinoma poorly differentiated from large cells. In whom the association with positive immunohistochemical study for markers of poorly differentiated squamous cell carcinoma was confirmed. Discussion: The Clown Nose Sign is a nodular inflammatory lesion in the skin of the nasal tip as a manifestation of cutaneous metastasis of a visceral tumor. It has been associated with multiple neoplasms specially lung cancer in men and breast cancer in women. Despite its low frequency, it must be taken into account due to its impact on patient survival. Conclusions: The appearance of inflammatory lesions in nasal tip of rapid growth that do not respond to therapy, requires extension studies to analyze its etiology.



Keywords: Neoplasm metastasis. Lung neoplasms. Skin neoplasms. Nose neoplasms. Nose. Immunohistochemistry.