Infantile choriocarcinoma with cutaneous, liver, and lung metastases

First noticed as a flat, bluish lesion at infant's 10 days of age, its subsequent rapid growth led to an emergency department visit, where dermatology diagnosed a hemangioma and initiated propranolol treatment. The differential diagnosis of lesions presenting with cutaneous involvement (ordered most to least common) include: leukemia, Langerhans cell histiocytosis, neuroblastoma, rhabdoid tumor, rhabdomyosarcoma, primitive neuroectodermal tumor, choriocarcinoma, and adrenocortical carcinoma.1 Choriocarcinoma is notorious for its life-threating hemorrhagic metastases and famous for being the first solid tumor to be cured with chemotherapy alone (methotrexate, 1956).2 It arises from malignant placental B-hCG secreting trophoblastic cells and typically occurs in the setting of a molar pregnancy. Left untreated, the disease is usually fatal within 3 weeks of presentation.7 Chemotherapy and delayed surgical excision of metastases can be curative with long-term survival rates of around 80%.8 CONCLUSION_ A solitary cutaneous metastasis can be mistaken for infantile hemangioma both clinically and radiographically.