A 62-year-old man came to our department and complained with progressively enlarging and bleeding multiple reddish nodules on his face for 20 days. The patient had a previous history of hepatitis B without any treatment for 20 years. Three months ago, he was diagnosed as hepatocellular carcinoma (HCC) and multiple metastases (including lung and inferior vena cava). Then, he was treated with transcatheter arterial chemoembolization and antivirus drugs. The physical examination showed six reddish, firm, and nodules with diameters of 1 to 10 mm on his face. Some lesions accompanied with capillaries dilatation, rupture, and bleeding [Figure A and 1B]. Dermoscopic examination revealed homogenous, blurry milky-red area, multiple serpentine and arborizing vessels, and some irregular red lacunas over a milky-red areas [Figure C]. The skin biopsy from a bleeding nodule revealed a large number of mass tumor cells in dermis. The tumors were composed of pleomorphic cells with increased mitosis, and inter-cellular bleeding was noted [Figure D]. Furthermore, cutaneous metastases from HCC was confirmed by immunohistochemical staining [Figure E and 1F], which showed hepatocyte (+), arginase-1 (+), cytokeratin (+), Ki-67 (30%+), cytokeratin 19 (–), α-fetoprotein (–), carcinoembryonic antigen (–), and epithelial membrane antigen (–).
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