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CUTANEOUS PARANEOPLASTIC SYNDROMES

Paraneoplastic syndromes refer to the remote effects of underlying neoplastic diseases. The clinical syndromes can occur in various organ systems, including endocrine, neuromuscular, cardiovascular, cutaneous, hematologic, GI, and renal. The symptoms are not the direct effect of metastases or tumor invasion, but may result from substances produced by the tumor (eg. hormones, peptides, or cytokines) or from immunologic or inflammatory reactions between malignant and normal tissues.

Cutaneous paraneoplastic syndromes (Table 134-1) are diverse dermatologic entities that suggest the presence of a remote malignancy. In some instances, they may appear before a cancer diagnosis and contribute to the discovery of an occult cancer, or they may also indicate recurrence in a patient with prior remission of cancer. Consequently, prompt recognition of the cutaneous paraneoplastic syndromes may lead to the detection of an underlying malignancy at an early and highly-treatable stage. However, the paraneoplastic manifestations may predate the diagnosis of the related neoplasm by many months or years. If an underlying cancer is not detectible, careful followup should continue for several years.

Table 134-1Classic Paraneoplastic Dermatoses

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