Cutaneous Groin Metastasis as a Rare Presentation of Advanced Urothelial Carcinoma of the Bladder

Cutaneous metastases from urothelial carcinoma are rare and, when present, are associated with a poor prognosis. We report the case of a 70-year-old male with advanced urothelial carcinoma who developed biopsy-proven cutaneous metastases to the groin. The patient initially presented with hypoxia, worsening cancer-related pain, and a left groin rash. Before hospitalization, he had been treated with chemotherapy, radical cystectomy with ileal conduit, and pembrolizumab. Following discontinuation of immunotherapy because of immune-related toxicity, he later presented with hypoxia, worsening cancer-related pain, and a new groin rash that was ultimately confirmed to represent cutaneous metastasis. Imaging obtained during hospitalization revealed progression of metastatic disease involving the mediastinal lymph nodes, lungs, and bone. The patient ultimately died of disease progression. This case highlights the importance of recognizing atypical metastatic presentations, managing immunotherapy-related toxicities, and incorporating early palliative care discussions.