Cutaneous markers of internal malignancy
What are cutaneous markers of internal malignancy?
Skin changes can often be the first sign of a deeper problem including an internal malignancy. Signs of skin disease may precede, occur with, or follow the detection of an associated cancer. These skin diseases can be a feature of an undiagnosed cancer and may be the prompt for a thorough examination in patients. Or in a patient whose cancer is in remission, these skin diseases may be the initial sign of the cancer recurring.
Cutaneous markers can be classified into 2 major types:
- Genetically determined syndromes with a cutaneous component (genodermatoses) that predispose at risk individuals to develop cancer
- Paraneoplastic syndromes which occur as a result of circulating factor(s) or presumed factors produced by the underlying cancer
Skin diseases that come under the group of genodermatoses include:
- Birt–Hogg–Dubé syndrome
- Cowden disease
- Gardner syndrome
- Gorlin syndrome (basal cell naevus syndrome)
- Multiple endocrine neoplasm type 2B
- Peutz-Jeghers syndrome
- Torre-Muir syndrome
- Progeria (premature aging syndromes)
Cutaneous paraneoplastic syndromes can be categorised according to the type of lesion they produce.
As well as cutaneous signs and symptoms, paraneoplastic syndromes may affect endocrine, neuromuscular, musculoskeletal, cardiovascular, haematological, gastrointestinal or renal function.
Paraneoplastic symptoms may be caused by:
- Immune reaction: antibodies, T cells or cytokines
- Hormones or hormone precursors
- Embryonic or fetal proteins
- Altered metabolic pathways
- Unknown factors