cutaneous metastasis ( cm ) from underlying carcinoma is relatively uncommon in clinical practice , 5.3% . breast carcinoma ( 69% ) is the most common cause of cm in women , followed by carcinoma of the large intestine ( 9% ) , lungs and ovaries ( 4% ) . these lesions often mimic benign skin lesions and present as localized nodules ( most common ) , cicatricial plaques , fibrotic plaques , alopecia neoplastica , zosteriform eruptions and bullous lesions . a high index of suspicion is required to diagnose these lesions as clinical findings may be subtle . fine needle aspiration cytology ( fnac ) is commonly employed for diagnosing these skin lesions . however , it is often difficult to aspirate adequate material from small papular lesions . in these clinical situations , fine needle non - aspiration cytology ( fnnac ) fnnac eliminates the negative suction pressure employed in fnac and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material . we report here a case in which fnnac was used in place of fnac in diagnosing papular skin lesions . this procedure was carried out in a treated patient of carcinoma breast who was on regular follow - up and presented to us with a 20-day history of papular skin lesions over her chest and back . a 48-year - old woman was diagnosed with invasive ductal carcinoma of the left breast 4 years ago . she was put on hormone therapy and was on regular follow - up for the last 4 years . from the last 20 days , she was complaining of painful erythmatous papular skin lesions over her chest and back . physical examination revealed multiple round - oval papulovescicular , tender cutaneous lesions ranging in size from 0.2 cm to 0.5 cm in the background of diffuse erythema , scattered over the left side of the chest wall , anterior abdominal wall and back [ figure 1 ] . clinial photograph showing papulovescicular lesions over the anterior chest wall ( arrow ) a high index of suspicion for recurrence was made and the patient was advised for fnac by the clinician . fine needle aspiration was not successful in this case as the lesions were very small , difficult to fix and yielded inadequate material . alternatively , fnnac was performed from the chest wall and back lesions to get adequate material . cytology findings were similar from both sites and revealed sheets of pleomorphic cells with a high nucleo - cytoplasmic ratio and prominent nucleoli forming a glandular pattern [ figure 2 ] . cm from patients of breast carcinoma is not rare , and it is reported in around 23.9% of cases . in most of the cases , it appears within 5 years after the excision and is usually nodular . they can be single or multiple and are usually 1.5 - 2.0 cm in size . the peculiar feature in our patient was the presence of very small ( < 0.5 cm ) and extensive papulovescicular skin lesions that were difficult to fix and aspirate . it was first used in france in 1982 for breast tumor and later for thyroid , orbital , periorbital and cutaneous tumors . fnnac sampling eliminates the negative suction pressure employed in fnac , resulting in less dilution by blood . the important advantages of fnnac sampling are easy operation and control over operating hand , especially for neck , breast , cutaneous or subcutaneous tissues . in our case , maurya et al . in his study also found that non - aspiration sampling has more cellular material , less blood , less cellular trauma and better retention of architecture . however , he concluded that better diagnostic accuracy can be achieved by combining both the techniques . this article enlightens the clinicians about the utility of fnnac , which is a relatively uncommon procedure .
cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice 
 . a high index of suspicion is required to diagnose these lesions , as these lesions can mimic benign skin lesions and clinical findings may be subtle . 
 fine needle aspiration cytology ( fnac ) is commonly employed for diagnosing these skin lesions . however , it is often difficult to aspirate adequate material from small papular lesions . in these clinical situations , fine needle non - aspiration cytology ( fnnac ) 
 is proposed as an alternative procedure . 
 fnnac eliminates the negative suction pressure employed in fnac and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material . 
 we report here a case in which fnnac was used in place of fnac in diagnosing papular skin lesions . 
 this procedure was carried out in a treated patient of carcinoma breast who was on regular follow - up and presented to us with a 20-day history of papular skin lesions over the chest and back . 
 this article enlightens the clinicians about the utility of fnnac , which is a relatively uncommon procedure .