Cutaneous metastases from carcinoma of the bile duct

A 68-year-old woman was admitted because of pain- less obstructive jaundice of three days duration when she noticed yellow colored sclerae and dark colored urine. Two months before presentation, she noticed a reddish, gradually enlarging, skin nodule at the neck above the left supraclavicular area whereas a second lesion was noticed on the chest above the xyphoid 20 days before her admission. On physical examination the skin and sclerae appeared yellow. The nodule at the neck was well circumscribed with erythema, measuring approximately 2 cm in diameter (Fig. 1A) whereas the chest lesion was a 0.8-cm red papule (Fig. 1B). Both lesions were asymptomatic, hard on palpation, not fixed to the underlying tissues and non-tender. Abdominal examination revealed mild tenderness in the right upper abdominal quadrant but no mass was palpable. There were no enlarged neck, axillary or inguinal lymph nodes.