Cutaneous Colon Cancer Metastases in a Surgical Scar
A 59-year-old man with metastatic colon cancer was referred to the dermatology clinic for a possible case of shingles. He had a 10-week history of painless and nonpruritic skin lesions coalescing around a large abdominal scar from a hemicolectomy performed 3 years earlier. A subsequent liver resection and cholecystectomy had also been performed through this incision. On examination, the lesions were firm, pink to violaceous in color, and vesicular-appearing; the presence of ascites was also evident. In this clinical context, cutaneous metastases were considered most likely, and a skin biopsy confirmed the diagnosis of metastatic colon adenocarcinoma. The most common site of cutaneous metastases in colon adenocarcinoma is the abdominal skin, sometimes in or around surgical scars, as was seen in this case. The patient ultimately received hospice care and died 5 months after this presentation.
Fascinating case. The first 🗝️ clue of no shingles should have been lack of pain and itch, you agree?
Thank you for the vast information! That's an interesting atypical one, and I'm glad to know now that it exists. But in regards to pain or numbness, isn't that almost always present?
Can I Have Shingles Without a Rash? Overview Shingles without a rash is called “zoster sine herpete” (ZSH). It’s not common. It’s also difficult to diagnose because the usual shingles rash isn’t present. The chickenpox virus causes all forms of shingles. This virus is known as varicella zoster virus (VZV). If you’ve had chickenpox, the virus will remain dormant in your nerve cells. Experts don’t fully understand what causes the virus to reactivate and why it only reactivates in some people. When VZV reappears as shingles, the virus is known as herpes zoster. Keep reading to learn more about this condition and what to expect if you develop shingles without a rash. What are the symptoms of shingles without a rash? The symptoms of ZSH are similar to the symptoms of shingles, but without a rash. The symptoms are usually isolated to one side of the body and commonly occur on the face and neck, and in the eyes. Symptoms can also occur in the internal organs. Typical symptoms include: a painful burning sensation itchiness a feeling of numbness a headache fatigue a general achy feeling pain that radiates from the spine sensitivity to touch What causes shingles without a rash? No one fully understands why VZV reactivates as shingles in some people. Shingles often occurs in people with compromised immune systems. Your immune system may become compromised because of: chemotherapy or radiation for cancer HIV AIDS high doses of corticoid steroids an organ transplant high stress levels Shingles isn’t contagious. You can’t give someone else shingles. If you have shingles and are in contact with someone who hasn’t had chickenpox or wasn’t vaccinated for chickenpox, you can give that person chickenpox. That person would have to come in direct contact with your shingles rash. If you have shingles without a rash, you shouldn’t be able to pass it to others. Still, it’s a good idea to avoid contact with people who haven’t had chickenpox as well as pregnant women until your other symptoms have cleared up. Who’s at risk for shingles? You can only get shingles if you’ve had chickenpox in the past. You’re at an increased risk for shingles if you: are over age 50 have a weakened immune system are under stress from surgery or trauma SUBSCRIBE Healthline uses cookies to improve your experience and to show you personalized ads. Privacy Policy. ACCEPTMore information Can I Have Shingles Without a Rash?  Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI — Written by Marjorie Hecht — Updated on November 6, 2018 Symptoms Causes Risk factors Diagnosis Treatment Outlook Takeaway Overview Shingles without a rash is called “zoster sine herpete” (ZSH). It’s not common. It’s also difficult to diagnose because the usual shingles rash isn’t present. The chickenpox virus causes all forms of shingles. This virus is known as varicella zoster virus (VZV). If you’ve had chickenpox, the virus will remain dormant in your nerve cells. Experts don’t fully understand what causes the virus to reactivate and why it only reactivates in some people. When VZV reappears as shingles, the virus is known as herpes zoster. Keep reading to learn more about this condition and what to expect if you develop shingles without a rash. What are the symptoms of shingles without a rash? The symptoms of ZSH are similar to the symptoms of shingles, but without a rash. The symptoms are usually isolated to one side of the body and commonly occur on the face and neck, and in the eyes. Symptoms can also occur in the internal organs. Typical symptoms include: a painful burning sensation itchiness a feeling of numbness a headache fatigue a general achy feeling pain that radiates from the spine sensitivity to touch What causes shingles without a rash? No one fully understands why VZV reactivates as shingles in some people. Shingles often occurs in people with compromised immune systems. Your immune system may become compromised because of: chemotherapy or radiation for cancer HIV AIDS high doses of corticoid steroids an organ transplant high stress levels Shingles isn’t contagious. You can’t give someone else shingles. If you have shingles and are in contact with someone who hasn’t had chickenpox or wasn’t vaccinated for chickenpox, you can give that person chickenpox. That person would have to come in direct contact with your shingles rash. If you have shingles without a rash, you shouldn’t be able to pass it to others. Still, it’s a good idea to avoid contact with people who haven’t had chickenpox as well as pregnant women until your other symptoms have cleared up. HEALTHLINE RESOURCE COVID-19: How we’re finding hope in the heartache We’re sharing five stories of how people like you coped with the challenges of the pandemic. Learn how they built resilience and found joy over the past year, and get tips for your own life, too. Enter your email SUBSCRIBE Your privacy is important to us Who’s at risk for shingles? You can only get shingles if you’ve had chickenpox in the past. You’re at an increased risk for shingles if you: are over age 50 have a weakened immune system are under stress from surgery or trauma How’s shingles without a rash diagnosed? Shingles without a rash isn’t common, but it may be more common than previously thought because it often goes undiagnosed. Shingles without a rash is difficult to diagnose based on your symptoms alone. Your doctor may test your blood, cerebrospinal fluid, or saliva to identify the presence of VZV antibodies. This will allow them to confirm a diagnosis of shingles without a rash. However, these tests are often inconclusive. Your medical history may provide clues that suggest you have shingles without a rash. Your doctor may ask if you’ve had a recent operation or if you’re under increased stress. How’s shingles without a rash treated? Once your doctor suspects you have VZV, they’ll use antiviral medicines such as acyclovir (Valtrex, Zovirax) to treat the shingles. They may also prescribe drugs for the pain. Other treatment will vary based on the location and severity of symptoms. What’s the outlook? Shingles with a rash usually clears up within two to six weeks. If you have shingles without a rash, your symptoms should clear up in a similar amount of time. In a few cases, the pain can remain after the shingles rash has healed. This is called postherpetic neuralgia (PHN). One case study Trusted Source suggests that people who have shingles without a rash are more likely to develop PHN than people who have the rash. If you have a weakened immune system and shingles without a rash, you also may be more likely to have shingles again. In general, people who get the shingles vaccine have less severe shingles and a lower chance of having PHN. The shingles vaccine is recommended for people 50 years and older.
Surgical explorationPreparation for USMLE
