Bluish Papule in a Middle-aged Man

At the time of his initial diagnosis of chordoma in 1996, he had been treated with surgical excision and postoperative radiation therapy. The incidence of chordoma metastases, generally occurring late in the course of the disease, has varied between 3% and 48% in the literature.3 Skin involvement has been reported to account for between 4% and 38% of chordoma metastases, with lung, liver, bone, and lymph node metastases accounting for the remainder.3 Cutaneous lesions of chordoma are generally described as nontender, firm, flesh-colored, smooth-surfaced nodules of various sizes.4 They are usually the result of direct extension or local recurrence.5,6 Less commonly, they are caused by distant metastasis.6 A retrospective review by Su et al6 found that 19 (9%) of 207 pathologically proved cases of chordoma had skin involvement.