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A 59-year-old man with metastatic colon cancer was referred to the dermatology clinic for a possible case of shingles. He had a 10-week history of painless and nonpruritic skin lesions coalescing around a large abdominal scar from a hemicolectomy performed 3 years earlier. A subsequent liver resection and cholecystectomy had also been performed through this incision. On examination, the lesions were firm, pink to violaceous in color, and vesicular-appearing; the presence of ascites was also evident. In this clinical context, cutaneous metastases were considered most likely, and a skin biopsy confirmed the diagnosis of metastatic colon adenocarcinoma. The most common site of cutaneous metastases in colon adenocarcinoma is the abdominal skin, sometimes in or around surgical scars, as was seen in this case. The patient ultimately received hospice care and died 5 months after this presentation.

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