Paraneoplastic Dermatoses at a Glance
- Skin can be a marker for internal malignancy.
- Familial cancer syndromes.
- Direct tumor extension.
- Paraneoplastic dermatoses follow a parallel course with the malignancy and allow early diagnosis and monitoring.
- Dermatoses with high associations with internal malignancy include tripe palms, Bazex syndrome, paraneoplastic pemphigus, erythema gyratum repens, necrolytic migratory erythema, and hypertrichosis lanuginose acquisita.
- Weakly associated with internal malignancy are acanthosis nigricans, acquired ichthyosis, and multiple seborrheic keratoses.
- Management of the dermatosis is the treatment of the malignancy.
Cutaneous manifestations of cancer can present with a variety of clinical findings that may reflect direct involvement of malignant cells, an epiphenomenon of a distant malignancy, or in the context of a familial cancer syndrome. The term “paraneoplastic dermatoses” refers to dermatoses (often unique) secondary to a distant cancer. There are two essential criteria: (1) the dermatosis must develop only after the development of the malignant tumor, even though some tumors may be asymptomatic and occult and (2) both the dermatosis and the malignant tumor follow a parallel course in that complete removal of the cancer results in clearing of the dermatosis and recurrence of the cancer causes relapse of the dermatosis. A suggested classification of clinicopathologic categories is shown in Table 153-1.
Table 153-1 Classic Paraneoplastic Dermatoses |Favorite Table|Download (.pdf)
Table 153-1 Classic Paraneoplastic Dermatoses
Major Internal Malignancy
Percent with Cancer
Approach to the Patient
Adenocarcinomas: intra-abdominal; gastric (50%–60%)
CBC, CMP, fasting blood glucose; upper endoscopy or CT scan of abdomen if history supports
Older age, rapid course, and oral involvement more common in malignancy associations.
Usually with insulin resistance.
Hodgkin's lymphoma (70%–80%)
CBC, CXR; consider CT of abdomen to rule out lymphoma
Spares flexures, palms, soles; up to 30% of cases may occur in patients with AIDS
Hepatocellular, gastric carcinoma
CMP, RPR, HIV
Type I: African/Asian; <30 lesions, high rate malignancy
Type II: Caucasians, familial; >30 lesions, cancer rare
Lung CA most common; gastric CA second
CBC, CMP, CT of chest and abdomen
Coexists with acanthosis nigricans in 75%
Adenocarcinomas: GI (47%); lymphoproliferative (20%)
CBC, imaging of GI tract
Early onset, eruptive nature, and pruritus are paraneoplastic features; coexists with acanthosis nigricans in 20%
SCC of upper aerodigestive tract
ENT exam; CXR; thoracoabdominal CT
Acral papulosquamous lesions (ears, nose), paronychia, onychodystrophy
Women: ovarian and breast CA
Men: GI and respiratory tract CA
CBC, CMP, CXR; up to date cancer screenings, bimanual exam in women; CA-125, CT chest, abdomen, pelvis in select cases
Patients older than in idiopathic form; males predominate; refractory or flaring of previously well controlled disease may signal malignancy
Progressive systemic sclerosis
Lung; SCC of the tongue (25× increased risk)
Annual oral exam; pulmonary function test
Decreased pulmonary CO diffusion (<70%) risk factor for lung CA