Signs of malignancy

Learning objectives
Signs of internal malignancy
Malignancy as a sign of internal disease
Activity

Learning objectives

Recognise potential cutaneous signs of malignancy

Signs of internal malignancy

A group of rare cutaneous disorders are associated with internal cancer and are considered paraneoplastic syndromes. However, benign variants are more common for many of these conditions.

Acanthosis nigricans
Hyperpigmented velvety thickening of neck, axillae and other body folds Associated with insulin resistance, obesity and malignancy of GI or GU tract Malignant variety affects hands & feet
Dermatomyositis
Heliotrope eyelids; erythema face, neck, upper trunk Flat papules on knuckles Associated in elderly with malignancy of breast, lung, GI tract, ovary & uterus
Necrolytic migratory erythema
Crusting erosions around mouth, nose and genitals Associated with glucagonoma (alpha-cell tumour of pancreas)
Acquired ichthyosis
Sometimes associated with cachexia and particularly with non-Hodgkin's lymphoma
Paraneoplastic acrokeratosis (Bazex syndrome)
Psoriasis-like or honeycomb keratoderma of hands, feet, nose, ear Associated with squamous cell carcinoma of upper respiratory or gastrointestinal tracts
Erythema gyratum repens
Migrating and pruritic annular erythema with concentric whirling rings Associated with lung cancer
Sign of Léser Trelat
Eruptive seborrhoeic keratoses arising in patient with cancer
Cowden's disease
Autosomal dominant cutaneous hamartomas (esp. tricholemmomas) Associated with breast and thyroid cancers
Paraneoplastic pemphigus
Severe erosions of mucous membranes associated with erythema multiforme-like blistering on trunk and limbs. Characteristic direct immunofluorescence staining. Associated with malignancy especially lymphoma

Malignancy as a sign of internal disease

Some malignant skin tumours may indicate the presence of an internal cancer.

Bowen's disease (squamous cell carcinoma in situ)
Red scaly plaques When multiple and in non-sun exposed sites, may be due to arsenic ingestion, associated with internal malignancies
Paget’s disease
Eczema-like red scaly plaque Mammary Paget's is associated with intraductal breast cancer Extramammary Paget's (flexural lesions) is associated with eccrine, apocrine, GI or GU cancer
Cutaneous metastases
Solitary or multiple firm or hard dermal nodules deposited via lymphatic or haematogenous spread Most often breast, GI, lung, melanoma, GU origin
T cell lymphoma
Erythematous bizarre-shaped scaly patches, plaques and nodules or erythroderma CTCL is a malignancy of helper T cells (CD4+) and involves entire lymphoreticular system but nearly always first manifests in the skin
B cell lymphoma
Asymptomatic reddish, purple or brown plaques and nodules Sometimes confined to the skin (rare) but more often associated with systemic B cell lymphoma
Kaposi's sarcoma
Mucocutaneous violaceous plaques and nodules Vascular neoplasm in immunocompromised especially acquired immunodeficiency syndrome Often systemic Due to herpes virus 8