Presentation and management of a patient with subcutaneous metastatic transitional cell carcinoma of the bladder

Background: A 60-year-old female with a 6-month history of muscle-invasive transitional cell carcinoma of the bladder presented with an enlarging subcutaneous lesion involving her right flank. She had previously undergone radical cystectomy, bilateral pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction. Investigations: Axial fused fluorodeoxyglucose PET-CT of the chest, abdomen and pelvis, fine needle aspiration with direct ultrasound guidance, excisional biopsy and immunohistochemistry. Diagnosis: Subcutaneous and liver metastases of transitional cell carcinoma. Management: Wide local excision of the subcutaneous lesion followed by combination gemcitabine-cisplatin chemotherapy. Gemcitabine was administered at a dose of 1,000 mg/m² on days 1, 8, and 15, and cisplatin was administered at a dose of 75 mg/m² on day 1; the schedule was repeated every 28 days for three cycles.