Acral cutaneous metastasis from a primary breast carcinoma following chemotherapy with bevacizumab and paclitaxel

Acral cutaneous metastasis from internal malignancy is rare, and the pathogenesis is not completely understood. We present the case of a 54-year-old black woman with a history of breast cancer diagnosed 2 years prior who developed multiple cutaneous metastases to acral sites involving the palmar and plantar surfaces of the hands and feet. This case represents an unusual metastatic pattern of breast carcinoma that arose after treatment with bevacizumab, an angiogenesis inhibitor that binds vascular endothelial growth factor A. We propose that bevacizumab-induced vascular changes localized to acral skin may have contributed to the metastatic pattern seen in our patient.