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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Signs of malignancy

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

Learning objectives

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
Acanthosis nigricans
Dermatomyositis
  • Heliotrope eyelids; erythema face, neck, upper trunk
  • Flat papules on knuckles
  • Associated in elderly with malignancy of breast, lung, GI tract, ovary & uterus
Dermatomyositis
Necrolytic migratory erythema
  • Crusting erosions around mouth, nose and genitals
  • Associated with glucagonoma (alpha-cell tumour of pancreas)
Necrolytic migratory erythema
Acquired ichthyosis
  • Sometimes associated with cachexia and particularly with non-Hodgkin's lymphoma
Acquired ichthyosis
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
Paraneoplastic acrokeratosis (Bazex syndrome)
Erythema gyratum repens
  • Migrating and pruritic annular erythema with concentric whirling rings
  • Associated with lung cancer
Erythema gyratum repens
Sign of Léser Trelat
  • Eruptive seborrhoeic keratoses arising in patient with cancer
Sign of Leser Trelat: seborrhoeic keratoses
Cowden disease
  • Autosomal dominant cutaneous hamartomas (esp. tricholemmomas)
  • Associated with breast and thyroid cancers
Cowden disease
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
Paraneoplastic pemphigus

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
Squamous cell carcinoma in situ
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
Paget disease
Cutaneous metastases
  • Solitary or multiple firm or hard dermal nodules deposited via lymphatic or haematogenous spread
  • Most often breast, GI, lung, melanoma, GU origin
Cutaneous metastases
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
T cell lymphoma
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
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
Kaposi's sarcoma

Activity

Look for cutaneous signs of malignancy in your patients with cancer.

 

Page 7 of 7. End of course. Back to: Cutaneous signs of systemic disease contents.

Related information

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Author: Clin Assoc Prof Amanda Oakley

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