Presentation and management of a patient with subcutaneous metastatic transitional cell carcinoma of the bladder

This Case Study describes a 60-year-old woman who presented with an enlarging subcutaneous lesion on her right flank, 6 months after having undergone treatment for transitional cell carcinoma (TCC) of the bladder. The article highlights that rare cutaneous TCC metastases can mimic common benign and inflammatory processes, and the authors suggest treatment options for such patients. Background A 60-year-old female with a 6-month history of muscle-invasive transitional cell carcinoma of the bladder presented with an enlarging subcutaneous lesion involving her right flank. She had previously undergone radical cystectomy, bilateral pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction. Investigations Axial fused fluorodeoxyglucose PET–CT of the chest, abdomen and pelvis, fine needle aspiration with direct ultrasound guidance, excisional biopsy and immunohistochemistry. Diagnosis Subcutaneous and liver metastases of transitional cell carcinoma. Management Wide local excision of the subcutaneous lesion followed by combination gemcitabine–cisplatin chemotherapy. Gemcitabine was administered at a dose of 1,000 mg/m 2 on days 1, 8, and 15, and cisplatin was administered at a dose of 75 mg/m 2 on day 1; the schedule was repeated every 28 days for three cycles.