Late-onset erysipelas-like cutaneous metastasis of gastric cancer involving the genital and umbilical regions: a case report

Introduction and importance: Cutaneous metastasis from gastric cancer is a rare clinical event, typically signifying advanced disease. Carcinoma erysipeloides (CE) is a subtype of inflammatory cutaneous metastasis that often presents similarly to infectious lesions, such as cellulitis. Delayed-onset CE in highly atypical locations, such as the genital region, is exceptionally uncommon and poses a significant diagnostic challenge. Case presentation: A 70-year-old woman who underwent laparoscopic distal gastrectomy for Stage IB gastric cancer 6 years prior presented with a 3-month history of painful, dark-red swelling in the genital region. She was initially treated for suspected cellulitis with antibiotics; however, the lesions were refractory to therapy. Computed tomography revealed increased subcutaneous fat density in the genital region and an umbilical mass. A skin biopsy confirmed metastatic signet-ring cell carcinoma consistent with the patient’s primary gastric cancer. She was diagnosed with cutaneous metastasis following surgery for gastric cancer and received 14 cycles of modified folinic acid, fluorouracil, and oxaliplatin 6 chemotherapy, achieving marked clinical improvement. The patient remains in complete remission 22 months after completing treatment. Clinical discussion: This case is notable for its unusually long 6-year disease-free interval and rare metastatic involvement of the genital region. While CE usually involves the trunk or neck, our literature review suggests this may be the first documented case of erysipelas-like metastasis to the genital region from gastric cancer. Conclusion: During follow-up after surgery for gastric cancer, clinicians should consider this metastatic pattern and promptly perform a biopsy of inflammatory skin lesions that are resistant to treatment.