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Shah MH, Ferrazzano C, Karthikeyan A, Hejazi H, Bhattacharya A, Andrew Awuah W, Isik A. Bazex Syndrome (Acrokeratosis Paraneoplastica): A Narrative Review of Pathogenesis, Clinical Manifestations, and Therapeutic Approaches. Cureus 2023; 15:e45368. [PMID: 37720135 PMCID: PMC10505057 DOI: 10.7759/cureus.45368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 09/19/2023] Open
Abstract
Acrokeratosis paraneoplastica, also known as Bazex syndrome, is a relatively understudied yet clinically important dermatological condition that is inextricably associated with squamous cell carcinoma, predominantly of the upper respiratory and gastrointestinal tracts. Manifesting as unique psoriasis-like cutaneous lesions, Bazex syndrome functions as an early warning signal for underlying malignancies, underscoring the urgent need for its timely diagnosis and intervention. Notwithstanding its clinical relevance, the molecular and cellular mechanisms underpinning its pathogenesis are not fully understood. To address these gaps, this comprehensive literature review undertook a meticulous search across reputable databases such as EMBASE, MEDLINE/PubMed, and Web of Science. Our analysis ventures into multiple putative pathogenic pathways, including shifts in Th2 immune responses, aberrant secretion of growth factors, and immunological reactions to tumor-specific antigens. We also detail the clinical phenotypes of Bazex syndrome and their chronological linkage with the corresponding malignancies. Finally, the review evaluates the therapeutic effectiveness of various approaches, including but not limited to targeted cancer treatments, PUVA therapy, and topical corticosteroids. This synthesis aims to arm healthcare providers with a nuanced understanding of Bazex syndrome, facilitating more accurate diagnosis and tailored treatment paradigms.
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Affiliation(s)
- Muhammad Hamza Shah
- Centre for Anatomy, Deanery of Biomedical Sciences, The University of Edinburgh, Edinburgh, GBR
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Carlo Ferrazzano
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Anhukrisha Karthikeyan
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Hamad Hejazi
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Anushri Bhattacharya
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | | | - Arda Isik
- Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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2
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Pharyngeal-Esophageal Malignancies with Dermatologic Paraneoplastic Syndrome. Life (Basel) 2022; 12:life12111705. [PMID: 36362860 PMCID: PMC9693568 DOI: 10.3390/life12111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Systemic changes often send signals to the skin, and certain neoplastic diseases of the internal organs can also trigger skin manifestations. In this article, the authors make clinical photography presentations of the patients seen at our clinic with dermatologic paraneoplastic syndromes within pharyngeal–esophageal malignancies, describe several paraneoplastic dermatoses, and also review high-quality scientific literature in order to be able to highlight the dermatological signs of pharyngoesophageal malignant tumors. The majority of our patients with paraneoplastic dermatoses, filtering for pharyngoesophageal malignancies, had esophageal neoplasms, out of whom seven were female and two were male, making esophageal cancer more common within the paraneoplastic dermatoses within pharyngoesophageal malignancies. An early recognition of paraneoplastic dermatoses can diagnose neoplasms and sequentially contribute to a better prognosis for the patient. This matter is also useful for front-line medical personnel in order to improve early diagnosis of the underlying malignancy, curative interventions with prompt therapy administration and good prognosis.
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3
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Abstract
Malignancy is the second leading cause of death in the United States, following heart disease. In most cancers, early detection is one of the most important factors in determining prognosis. As clinicians it is therefore important to be aware of potential clues of underlying malignancy on physical examination. Given the wide range of malignancies, and the heterogeneous nature of their presentations, this article is by no means exhaustive. Instead, it discusses in depth some of the more frequently encountered physical examination findings that may suggest malignancy. Specifically, it covers lymphadenopathy, cutaneous findings related to various cancers, and malignancy related thrombosis.
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Affiliation(s)
- Kristen D Kelley
- Division of General Internal Medicine, UC Davis Heath, 4150 V Street, Suite 2400, Sacramento, CA 95817, USA.
| | - Paul Aronowitz
- UC Davis Health, 4150 V Street, Suite 2400, Sacramento, CA 95817, USA
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4
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Castro Silva R, Castro Silva G, Castro Silva MC, Lupi O. Erythema gyratum repens after COVID-19. J Eur Acad Dermatol Venereol 2021; 35:e859-e861. [PMID: 34363628 PMCID: PMC8450813 DOI: 10.1111/jdv.17583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- R Castro Silva
- Dermatology Section, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, Brazil
| | - G Castro Silva
- Dermatology Section, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, Brazil
| | - M C Castro Silva
- Dermatology Section, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, Brazil
| | - O Lupi
- Dermatology Section, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.,Immunology Section, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Dermatology Section, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, Brazil
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5
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Rahman SU, Sana MK, Tahir Z, Ali A, Shah PA. Paraneoplastic syndromes in cholangiocarcinoma. World J Hepatol 2020; 12:897-907. [PMID: 33312417 PMCID: PMC7701960 DOI: 10.4254/wjh.v12.i11.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes are the symptoms or signs which result from damage to tissues that are distant from the site of malignancy, due to complex interactions between the body’s immune system and malignant neoplasm. Cholangiocarcinoma (CCA) is an aggressive epithelial malignancy of hepatobiliary tree and it is found to be associated with various paraneoplastic syndromes. These syndromes can present as dermatological, neurological, renal, hematological, or multi-systemic manifestations. Clinical suspicion and timely recognition of these syndromes can lead to early diagnosis of covert malignancies like CCA. The management plan remains the removal of the underlying cause which in this case is CCA.
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Affiliation(s)
- Saad Ur Rahman
- Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Muhammad Khawar Sana
- Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Zabreen Tahir
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Aamir Ali
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Pir Ahmad Shah
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78229, United States
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6
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GÜNEY D, ŞAHİN M. Nadir Görülen Bir Paraneoplastik Sendrom; Sweet Sendromu. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.811448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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7
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Cartron AM, Blaszczak A, Kaffenberger BH, Trinidad JCL. Approaching Target and Targetoid Eruptions in Inpatient Dermatology. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Abstract
Rash is a common complaint in a primary care setting. Erythema gyratum repens (EGR) is a unique rash strongly associated with malignancy. Sometimes this rash can precede the clinical presentation of malignancy, most commonly lung carcinoma. Even though this is an uncommon rash, physicians need to be aware of this condition for the prompt evaluation of malignancy to start the therapy. In this report we present the case of a 61-year-old gentleman with stage IV squamous cell carcinoma of the esophagus who presented with EGR two months after the diagnosis of his malignancy. The diagnosis was made based on clinical exam and histological findings. The patient was reassured and the rash was managed conservatively. Chemotherapy was continued and the rash was resolved in two months.
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Affiliation(s)
- Abhishek Matta
- Internal Medicine, University of North Dakota, Fargo, USA.,Internal Medicine, Sanford Health, Fargo, USA
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9
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Saeed A, Hameem ZU, Modi D, Park R, Saeed A. Cutaneous paraneoplastic syndrome associated with anal squamous cell carcinoma: a rare presentation of an uncommon cancer. Curr Oncol 2020; 27:e433-e435. [PMID: 32905348 PMCID: PMC7467788 DOI: 10.3747/co.27.6557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Paraneoplastic syndromes associated with anal squamous cell carcinoma (scc) are rare. Erythema gyratum repens (egr) is a cutaneous paraneoplastic syndrome with distinctive characteristics. Here, we report the rare case of a 73-year-old woman with a chronic erythematous rash for 11 months associated with intense pruritus. She was treated with prednisone and antihistamines by dermatologists, but did not respond. The patient was subsequently seen in our clinic for unintentional weight loss and anorexia with intermittent nausea and vomiting. During further evaluation with imaging studies, upper endoscopy, and colonoscopy with biopsy, poorly differentiated anal scc was identified. Biopsies of the skin rash were characteristic of egr. She was treated using concurrent chemotherapy with 5-fluorouracil and mitomycin C and pelvic radiation (50.4 Gy in 28 fractions) for anal scc. She tolerated the treatment, and her rash faded, with resolution of the pruritus.
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Affiliation(s)
- Az Saeed
- Department of Medicine, Division of Pathology and Laboratory Medicine
| | - Z U Hameem
- Department of Medicine, Division of Medical Oncology, Kansas University Medical Center, Kansas City, KS, U.S.A
| | - D Modi
- Department of Medicine, Division of Medical Oncology, Kansas University Medical Center, Kansas City, KS, U.S.A
| | - R Park
- Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, U.S.A
| | - An Saeed
- Department of Medicine, Division of Medical Oncology, Kansas University Medical Center, Kansas City, KS, U.S.A
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10
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Alter M, Mengoni M, Gaffal E. Hautveränderungen bei internen Neoplasien. J Dtsch Dermatol Ges 2020; 18:456-471. [DOI: 10.1111/ddg.14093_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/08/2020] [Indexed: 12/01/2022]
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11
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Alter M, Mengoni M, Gaffal E. Cutaneous manifestations of internal malignancy. J Dtsch Dermatol Ges 2020; 18:456-469. [PMID: 32311823 DOI: 10.1111/ddg.14093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/08/2020] [Indexed: 12/13/2022]
Abstract
Skin lesions associated with internal malignancy may present as cutaneous metastases or as typical lesions occurring in the context of certain cancer-associated genetic syndromes. Paraneoplastic syndromes, on the other hand, are only indirectly associated with an underlying malignancy and are not malignant per se. Historically, a distinction has been made between "obligate" and "facultative" paraneoplastic disorders, depending on the likelihood with which they are potentially associated with malignancy. In addition, there are nonspecific cutaneous manifestations that are only rarely associated with an underlying malignancy. Another possible classification is based on the pathophysiological mechanisms underlying the cutaneous lesions. In everyday practice, it is essential that dermatologists recognize potentially cancer-associated dermatoses, as this will frequently contribute to the initial diagnosis of an underlying neoplasm.
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Affiliation(s)
- Mareike Alter
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Miriam Mengoni
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Evelyn Gaffal
- Department of Dermatology, University Medical Center, Magdeburg, Germany
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12
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Sauvageau AP, Mojeski J, Fiorica TW, Miller CC. Erythema Gyratum Repens in Long-Term Smoker. Case Rep Dermatol 2019; 11:268-272. [PMID: 31762739 PMCID: PMC6873075 DOI: 10.1159/000503270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/08/2019] [Indexed: 11/19/2022] Open
Abstract
Erythema gyratum repens (EGR) is a rare paraneoplastic skin condition characterized by the eruption of expanding, concentric, erythematous patches and plaques. The condition may precede a symptomatic appearance of internal malignancy, and therefore provides a unique opportunity to prevent additional morbidity and mortality secondary to undetectable cancer growth. We report the case of a 71-year-old female patient clinically diagnosed with EGR and subsequently diagnosed with otherwise asymptomatic adenocarcinoma of the lung.
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Affiliation(s)
- Andrew P Sauvageau
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jacob Mojeski
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Thomas W Fiorica
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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13
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Caccavale S, Brancaccio G, Agozzino M, Vitiello P, Alfano R, Argenziano G. Obligate and facultative paraneoplastic dermatoses: an overview. Dermatol Pract Concept 2018; 8:191-197. [PMID: 30116663 PMCID: PMC6092071 DOI: 10.5826/dpc.0803a09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Dermatological paraneoplastic syndromes are a group of cutaneous diseases associated with malignancy, but not directly related to the primary tumor itself or to its metastases. It is of utmost importance for the dermatologist to recognize the major cutaneous paraneoplastic syndromes to diagnose the underlying tumors that trigger them as early as possible. In this overview, skin conditions that are highly correlated with malignancy, whose recognition implies a mandatory investigation of internal cancer, are described.
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Affiliation(s)
- Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Marina Agozzino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Vitiello
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, Italy
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15
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Milicic V, Ravic-Nikolic A, Jovovic-Dagovic B, Stojanovic S, Mitrovic SL. Generalized Pustular Psoriasis in Association with Squamous Cell Carcinoma of the Hypopharynx. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2016-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pustular psoriasis is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background. Very rarely pustular psoriasis represent a paraneoplastic dermatosis. In this report we describe a case of generalized pustular psoriasis (GPP) associated with advanced, inoperable, metastatic squamous cell carcinoma of the hypopharynx. We suggest that physicians should be alert for the worsening of existing psoriasis or formation of novel psoriasiform eruptions and should undertake clinical evaluation of possible neoplastic disease.
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Affiliation(s)
- Vesna Milicic
- Faculty of Medical Sciences , University of Kragujevac , Serbia
- Department of Dermatology , Clinical Center Kragujevac , Serbia
| | - Ana Ravic-Nikolic
- Faculty of Medical Sciences , University of Kragujevac , Serbia
- Department of Dermatology , Clinical Center Kragujevac , Serbia
| | | | - Stevan Stojanovic
- Department of Otorhinolaryngology , Clinical Center Kragujevac , Serbia
| | - Slobodanka Lj. Mitrovic
- Faculty of Medical Sciences , University of Kragujevac , Serbia
- Department of Pathology , Clinical Center Kragujevac , Serbia
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16
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Lechien JR, Khalife M, Saussez S. Acrokeratosis Paraneoplastica (Bazex Syndrome). EAR, NOSE & THROAT JOURNAL 2017; 96:413-414. [DOI: 10.1177/0145561317096010-1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jérôme R. Lechien
- From the Department of Otolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Rue Louis Cathy, Baudour, Belgium
- Laboratory of Phonetics, Faculty of Psychology Research Institute for Health Sciences and Technology University of Mons, Mons, Belgium
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, Research Institute for Health Sciences and Technology University of Mons, Mons, Belgium
| | - Mohamad Khalife
- From the Department of Otolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Rue Louis Cathy, Baudour, Belgium
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, Research Institute for Health Sciences and Technology University of Mons, Mons, Belgium
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17
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Mechid F, Hanni F, Ali E, Ben Mohand C, Sibilia J, Dahou C. Des lésions cutanées atypiques. Rev Med Interne 2016; 37:857-858. [DOI: 10.1016/j.revmed.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 11/27/2022]
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18
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Hejna M, Wöll E, Tschandl P, Raderer M. Cutaneous paraneoplastic disorders in stomach cancer: Collaboration between oncologically active dermatologists and clinical oncologists. Crit Rev Oncol Hematol 2016; 103:78-85. [PMID: 27247117 DOI: 10.1016/j.critrevonc.2016.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/14/2016] [Accepted: 04/26/2016] [Indexed: 01/25/2023] Open
Abstract
To our knowledge this is the first systemic review that provides an overview of the cutaneous paraneoplastic syndromes (CPS) (i.e., clinical manifestations, pathomechanisms, and treatment modalities) occurring in stomach cancer. CPS are caused by substances produced by stomach cancer and may precede, coincide with, or follow the diagnosis of this malignancy. More than 20 possible CPS in association with stomach cancer have been identified. CPS mostly compromises the patient's quality of life by skin impairment plus discomfort and are often associated with a dismal prognosis on survival. Studies of these CPS not only in stomach cancer have partially contributed to the understanding of pathomechanism and since CPS may be the presenting sign of an occult cancer, cognizance of their features and clinical implications are of considerable importance. Patients with these syndromes should have an appropriate work-up for a possibly occult malignancy with consecutive successful early treatment.
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Affiliation(s)
- Michael Hejna
- Comprehensive Cancer Center-GET, Medical University of Vienna, Vienna, Austria.
| | - Ewald Wöll
- St.Vinzenz Krankenhaus Betriebs GmbH, Zams, Austria
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Internal Medicine I, Division of Oncology Medical University of Vienna, Vienna, Austria
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Liau MM, Long V, Yang SS. Erythema gyratum repens: a paraneoplastic eruption. BMJ Case Rep 2016; 2016:bcr-2016-214665. [PMID: 26951443 DOI: 10.1136/bcr-2016-214665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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20
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Abstract
Bazex syndrome, a rare paraneoplastic syndrome characterized by psoriasiform eruptions, palmoplantar keratosis, and symmetric onychodystrophy, is most prevalent with squamous cell carcinomas of the upper aerodigestive tract.Here, we reported an uncommon case of Bazex syndrome about an 83-year-old man with pulmonary adenocarcinoma and osseous metastasis, Physical examination found psoriasiform eruptions on the nose, cheeks, ears, knees, and the dorsa of interphalangeal joints, along with plantar keratosis and symmetric onychodystrophy involving hands and feet. Imaging analyses pulmonary adenocarcinoma with both local metastatic nodules and osseous metastasis.Symptomatic treatment with topical corticosteroids and oral retinoids showed no improvement. A 4-month follow-up showed that Gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, successfully reduced primary tumor size and alleviated cutaneous lesions.Our report here highlighted a potential correlation between pulmonary adenocarcinoma and Bazex syndrome, which is characterized by hallmark nail destruction and preferential involvement of body extremities. Moreover, etiological therapy against underlying malignancy is essential for treating paraneoplastic Bazex syndrome.
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Affiliation(s)
- Jing Zhao
- From the Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, China
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21
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Hoffmann M, Visser WI, Ascott-Evans B, Hough FS. The prevalence and clinical significance of acanthosis nigricans in diabetic and non-diabetic women of mixed ancestry. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2015. [DOI: 10.1080/16089677.2015.1056473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lakhdar N, El Khattabi W, Lahroussi M, Afif H, Aichane A. [Small cell lung cancer associated with paraneoplastic bullous pemphigoid]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:169-172. [PMID: 24874405 DOI: 10.1016/j.pneumo.2013.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
The broncho-pulmonary small cell carcinoma is the most common cancer provider paraneoplastic syndrome especially neurological and endocrine but also cutaneous syndrome. Paraneoplastic dermatosis do not result from a direct extension of cancer and are not metastases, but their presence is suggestive of an underlying tumor. The evolution of the dermatosis is parallel to that of cancer: treating cancer results in the regression of cutaneous manifestations. We report an observation of a 44-year-old smoker, who was hospitalized for a tissue excavated process associated with bullous dermatosis. The transmural puncture biopsy finds small cell carcinoma. The skin biopsy objective bullous pemphigoid. The evolution under chemotherapy was marked regression of bullous lesions and the patient died later after metastatic extension. Cutaneous paraneoplastic syndrome appears only in a minority of cancer patients, but its recognition is very important for early diagnosis.
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Affiliation(s)
- N Lakhdar
- Service des maladies respiratoires, hôpital du 20 Août 1953, CHU Ibn Rochd, Casablanca, Maroc.
| | - W El Khattabi
- Service des maladies respiratoires, hôpital du 20 Août 1953, CHU Ibn Rochd, Casablanca, Maroc
| | - M Lahroussi
- Service des maladies respiratoires, hôpital du 20 Août 1953, CHU Ibn Rochd, Casablanca, Maroc
| | - H Afif
- Service des maladies respiratoires, hôpital du 20 Août 1953, CHU Ibn Rochd, Casablanca, Maroc
| | - A Aichane
- Service des maladies respiratoires, hôpital du 20 Août 1953, CHU Ibn Rochd, Casablanca, Maroc
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Abstract
Some skin conditions may require treatment in intensive care units. The early diagnosis of life-threatening dermatoses is a considerable challenge. We review skin diseases which may require intensive care. In addition to Stevens-Johnson syndrome and toxic epidermal necrolysis, representing adverse skin reactions, we discuss staphylococcal scalded skin syndrome and necrotizing fasciitis as infection-associated dermatoses, as well as angioedema. We focus on the course of disease describing clinical presentations, diagnostics and therapeutic strategies with respect to critical medical conditions.
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Affiliation(s)
- C Marks
- Abt. für Hämatologie/Onkologie, Medizinische Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
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Shah KR, Boland CR, Patel M, Thrash B, Menter A. Cutaneous manifestations of gastrointestinal disease. J Am Acad Dermatol 2013; 68:189.e1-21; quiz 210. [DOI: 10.1016/j.jaad.2012.10.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 01/13/2023]
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25
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Makrantonaki E, Liakou A, Eckardt R, Zens M, Steinhagen-Thiessen E, Zouboulis C. Hauterkrankungen beim geriatrischen Patienten. Hautarzt 2012; 63:938-46. [DOI: 10.1007/s00105-012-2466-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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26
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Gore M, Winters ME. Erythema gyratum repens: a rare paraneoplastic rash. West J Emerg Med 2012; 12:556-8. [PMID: 22224159 PMCID: PMC3236141 DOI: 10.5811/westjem.2010.11.2090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 10/28/2010] [Accepted: 11/01/2010] [Indexed: 12/02/2022] Open
Abstract
Erythema gyratum repens (EGR) is a rare and characteristic, paraneoplastic rash associated with a variety of malignancies, most notably lung, esophageal, and breast cancers. This case report details the appearance, epidemiology, diagnosis, and treatment of EGR. Prompt identification of EGR is essential, as the rash often precedes the diagnosis of malignancy by several months. Urgent patient referral to evaluate for malignancy is crucial, as this may lead to decreased morbidity and mortality.
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Affiliation(s)
- Marina Gore
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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Shah A, Jack A, Liu H, Hopkins RS. Neoplastic/paraneoplastic dermatitis, fasciitis, and panniculitis. Rheum Dis Clin North Am 2012; 37:573-92. [PMID: 22075198 DOI: 10.1016/j.rdc.2011.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The skin changes outlined in this article can be important clues to an underlying malignancy. Paraneoplastic dermatoses are skin disorders associated with an underlying neoplasm and whose course parallels that of the neoplasm. Recognizing these skin presentations leads to early diagnosis and management of the underlying malignancy. Effective treatment of the associated neoplasm often leads to improvement of the cutaneous manifestations and should be the primary focus of each patient's management.
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Affiliation(s)
- Anjali Shah
- Division of Dermatology, Department of Medicine, Loyola University Medical Center, Room 101, Building 54, 2160 South First Avenue, Maywood, IL 60153, USA
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Abstract
What is probably the first description of targetoid or iris lesions, as they appear in erythema multiforme (EM), can be found in Thomas Bateman's 1836 textbook "Practical Synopsis of Cutaneous Diseases According to the Arrangement of Dr. Willan." EM was initially described by Bateman and later by von Hebra as an acute self-limiting skin disease, symmetrically distributed on the extremities with typical concentric "targetoid" or "iris" lesions, and often recurrent. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were added to this syndrome later. A newer classification has created two disease spectra: EM consisting of EM minor and EM major (or bullous EM), and SJS and TEN. EM minor and EM major are often recurrent, postinfectious (especially after herpes and mycoplasma) disorders with low morbidity and almost no mortality. SJS and TEN are usually severe drug-induced reactions with high morbidity and poor prognosis. The target lesions found in each form of the disease are described and defined. Although the term "target lesion" originated from the description of EM and despite its being the dominant lesion in this disease, it is not pathognomonic for EM, and these lesions can sometimes appear in other diseases. Short descriptions of these other diseases are presented.
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MESH Headings
- Dermatitis, Allergic Contact/classification
- Dermatitis, Allergic Contact/pathology
- Erythema Multiforme/classification
- Erythema Multiforme/history
- Erythema Multiforme/pathology
- Hemangioma/classification
- Hemangioma/pathology
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Humans
- Lupus Erythematosus, Systemic/classification
- Lupus Erythematosus, Systemic/pathology
- Pemphigus/classification
- Pemphigus/pathology
- Pregnancy Complications/classification
- Pregnancy Complications/pathology
- Pruritus/classification
- Pruritus/pathology
- Skin Diseases/classification
- Skin Diseases/history
- Skin Diseases/pathology
- Skin Diseases, Vesiculobullous/classification
- Skin Diseases, Vesiculobullous/pathology
- Syphilis/classification
- Syphilis/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/classification
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
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Affiliation(s)
- Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, 76100 Rechovot, Israel (affiliated to the Hebrew University-Hadassah Medical School, Jerusalem, Israel).
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Abstract
Many cutaneous conditions can mimic infection. If these lesions are not accurately recognized, they may be treated with antimicrobial agents, which adds cost, potential risk, and inconvenience to the patient and the healthcare system. The presenting signs and symptoms of many ulcerating, pustular, morbilliform, bullous, neoplastic, granulomatous, autoimmune, and neutrophilic conditions, as well as clinical vasculitis, cellulitis, folliculitis, and panniculitis, have been mistaken for infection. This review emphasizes the clinical presentation, physical exam, and diagnostic workup of many of these conditions to assist the clinician in ascertaining the correct diagnosis. In addition, general treatment options are provided for each disease category.
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Affiliation(s)
- Janelle R Ricketts
- Dermatology Department, University of CT Health Center, Farmington, CT 06030, USA.
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Chrysomali E, Piperi E, Sklavounou-Andrikopoulou A. Oral acanthosis nigricans in chronic hepatitis B with a 21-year follow up. J Dermatol 2011; 38:1172-6. [PMID: 21966946 DOI: 10.1111/j.1346-8138.2011.01252.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acanthosis nigricans is a rare mucocutaneous disorder of unknown etiology that manifests as hyperpigmented velvety plaques, most often on intertriginous areas such as the neck and axillae as well as on mucosal sites such as the oral cavity. The disorder presents either as a paraneoplastic manifestation of an underlying malignancy, especially gastrointestinal adenocarcinomas or in association with obesity, administration of drugs or endocrinopathies, most commonly insulin-resistant diabetes mellitus. In the present article, a case of acanthosis nigricans with oral and cutaneous manifestations in a male patient with chronic hepatitis B infection is described. To the best of our knowledge, this is the first case of benign oral acanthosis nigricans associated with chronic hepatitis B.
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Affiliation(s)
- Evanthia Chrysomali
- Department of Oral Pathology and Medicine, Dental School, National and Kapodistrian University of Athens, Athens, Greece.
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Affiliation(s)
- Marcia Ramos-E-Silva
- Sector of Dermatology and Post Graduation Course of Dermatology, University Hospital Clementino Fraga Filho andSchool of Medicine, Federal University of Rio de Janeiro, 22280-020 Rio de Janeiro, Brazil.
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Zarzour JG, Singh S, Andea A, Cafardi JA. Acrokeratosis paraneoplastica (Bazex syndrome): report of a case associated with small cell lung carcinoma and review of the literature. J Radiol Case Rep 2011; 5:1-6. [PMID: 22470801 DOI: 10.3941/jrcr.v5i7.663] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acrokeratosis paraneoplastic (Bazex syndrome) is a rare, but distinctive paraneoplastic dermatosis characterized by erythematosquamous lesions located at the acral sites and is most commonly associated with carcinomas of the upper aerodigestive tract. We report a 58-year-old female with a history of a pigmented rash on her extremities, thick keratotic plaques on her hands, and brittle nails. Chest imaging revealed a right upper lobe mass that was proven to be small cell lung carcinoma. While Bazex syndrome has been described in the dermatology literature, it is also important for the radiologist to be aware of this entity and its common presentations.
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Affiliation(s)
- Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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De La Torre-Lugo EM, Sánchez JL. Erythema gyratum repens. J Am Acad Dermatol 2011; 64:e89-90. [PMID: 21496697 DOI: 10.1016/j.jaad.2010.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/30/2010] [Accepted: 10/13/2010] [Indexed: 02/06/2023]
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Noda S, Takekoshi T, Tamaki Z, Asano Y, Sugaya M, Sato S. Urticarial vasculitis presenting as erythema gyratum repens-like eruption. J Eur Acad Dermatol Venereol 2011; 25:493-5. [DOI: 10.1111/j.1468-3083.2010.03747.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The skin plays a critical role in the detection of internal malignances. Cutaneous signs of these disorders afford clinicians opportunities for early diagnosis and treatment. We aim to succinctly review the recognition, diagnosis, and treatment of selected cutaneous paraneoplastic diseases. Skin disorders that may be associated with paraneoplastic syndromes include: cutaneous metastases, tripe palms, Sweet's syndrome, glucagonoma, Paget's disease and extramammary Paget's disease, acanthosis nigricans, Birt-Hogg-Dube syndrome, basal cell nevus syndrome, Bazex syndrome (acrokeratosis paraneoplastica), carcinoid syndrome, Cowden's disease(multiple hamartoma syndrome), dermatomyositis, erythema gyratum repens, ichthyosis aquisita, von Recklinghausen's disease, pityriasis rotunda, pyoderma gangrenosum, Quincke's edema (angioedema and paraneoplastic uricaria), paraneoplastic pemphigus, Degos' disease, superior vena cava syndrome, Werner's syndrome, diffuse normolipemic plane xanthomas, and yellow nail syndrome. Treatment for these disorders depends on the nature and anatomic distribution of the primary neoplastic process.
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Abstract
Endocrine and metabolic diseases, besides affecting other organs, can result in changes in cutaneous function and morphology and can lead to a complex symptomatology. Dermatologists may see some of these skin lesions first, either before the endocrinologist, or even after the internist or specialist has missed the right diagnosis. Because some skin lesions might reflect a life-threatening endocrine or metabolic disorder, identifying the underlying disorder is very important, so that patients can receive corrective rather than symptomatic treatment. In this issue, we will review various hormone-secreting tumors, including pituitary disorders (Cushing's syndrome and acromegaly), hyperthyroidism, glucagonoma, carcinoid syndrome, mastocytosis, and hyperandrogenism. We will focus on clinical manifestations, mainly cutaneous, followed by a brief discussion on how to make the diagnosis of each condition in addition to treatment options.
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Affiliation(s)
- Serge A Jabbour
- Division of Endocrinology, Diabetes & Metabolic Diseases, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Tazi MF, Mellas S, Mellas N, Znati K, Tazi EM, Masbah O, Boubbou M, El Fassi MJ, Farih MH. Acanthosis nigricans, manifestation cutanée rare d’un carcinome urothélial de vessie: à propos d’un cas. ONCOLOGIE 2010. [DOI: 10.1007/s10269-009-1053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan E, Kuper-Hommel M, Rademaker M. Annular erythema as a sign of recurrent breast cancer. Australas J Dermatol 2010; 51:135-8. [PMID: 20546222 DOI: 10.1111/j.1440-0960.2009.00621.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Three women with known breast cancer presented with very similar annular erythemas of their chest walls. All women were in remission from their breast cancer for at least 6 months. Their breast cancers had initially responded well to multi-modality treatment with no clinical or radiologic evidence of recurrence, until the development of the annular erythema. In the first case, the annular erythema was treated unsuccessfully as a dermatitis and then as tinea corporis. In the second case, subacute cutaneous lupus was considered but lupus antibodies were negative. In the third case, the annular erythema was promptly recognized and biopsied. Histology in all three cases revealed identical findings of invasive ductal carcinoma involving the lymphatics of the skin. Immunohistochemical staining of the carcinoma was positive for human epidermal growth factor receptor 2 but negative for oestrogen and progesterone receptors. Annular erythema can pose a wide differential but rarely has it been described as a sign of locally recurrent cancer. These cases highlight the importance of recognizing this entity in the oncologic patient, where prompt skin biopsies can confirm the diagnosis and allow early initiation of therapy.
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Affiliation(s)
- Eugene Tan
- Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.
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Andriamanantena D, Boye T, Gervaise A, Vieu C, Splingard B, Dot JM, Veran Y, Margery J. [An unusual paraneoplastic manifestation in lung cancer: eosinophilic erythroderma]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:32-35. [PMID: 19306782 DOI: 10.1016/j.pneumo.2008.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Revised: 10/26/2008] [Accepted: 11/06/2008] [Indexed: 05/27/2023]
Abstract
An 81-year-old man was admitted for generalized weakness, erythrodermia and eosinophilia. His chest CT showed nodules related to lung adenocarcinoma. Chemotherapy induced a tumour response with the disappearance of the erythrodermia and eosinophilia. A tumour relapse indicating the recurrence of the erythrodermia and eosinophilia was confirmed 2 months after completion of the chemotherapy. The outcome was rapidly fatal. The evolution of the symptoms suggests that eosinophilic erythrodermia is a paraneoplastic syndrome. Cutaneous paraneoplastic syndromes are rare but may be associated with lung cancer.
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Affiliation(s)
- D Andriamanantena
- Service de dermatologie, hôpital d'instruction des armées de Legouest, 27, rue de Plantières, BP 10, 57998 Metz, France
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Milanez FM, Pereira CADC, Trindade PHDM, Milinavicius R, Coletta ENAM. Lung adenocarcinoma, dermatomyositis, and Lambert-Eaton myasthenic syndrome: a rare combination. J Bras Pneumol 2008; 34:333-6. [PMID: 18545831 DOI: 10.1590/s1806-37132008000500014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 07/31/2007] [Indexed: 11/22/2022] Open
Abstract
The incidence of lung neoplasms is increasing in Brazil and in the world, probably as a result of the increase in smoking. Due to the greater number of cases, atypical presentations appear. We report the case of a 66-year-old hypertensive male smoker who presented progressive proximal muscular weakness and, in two months, evolved to dysphagia, dysphonia, and V-shaped skin lesions on the chest. A chest X-ray showed a spiculated pulmonary nodule in the right upper lobe. The biochemical analysis revealed elevated creatine kinase levels. After complementary tests and biopsies, the patient underwent right upper lobectomy. Histopathology showed a moderately differentiated adenocarcinoma. The overall analysis of the case and a review of the literature allow us to suggest that the clinical profile of the patient was a result of an overlap of two paraneoplastic syndromes (dermatomyositis and Lambert-Eaton myasthenic syndrome) secondary to lung adenocarcinoma.
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Acanthosis nigricans and the sign of leser-trelat associated with primary brain tumor: Case report. ARCHIVE OF ONCOLOGY 2008. [DOI: 10.2298/aoo0804081s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The authors present a case of a female patient a 26-year old pensioner from Zmajevo, who developed skin changes in the neck region, armpits and groins, as well as in submammal folds during the 10 years period. The changes include dark-brown hyper?pigmentation associated with sudden eruption of a large number of benign skin tumors and dark-brown seborrheic keratosis on trunk and extremities. In 1998, after magnetic resonance imaging, primary brain tumor of astrocytoma type with low grade of malignity was discovered in thalamus region. The patient developed the above-mentioned skin changes since then. According to neurosurgical findings, the brain tumor is inoperable, so skin changes are persistent and stationary. Clinical changes correspond to paraneoplastic form of acanthosis nigricans. Numerous skin tumors histopathologically match seborrheic keratosis and reveal the clinical features of the sign of Leser-Trelat. It is interesting that in the same patient there are both, obligatory and optional, paraneoplastic dermatoses associated with malignant brain tumor.
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Gregoriou S, Korfitis C, Alestas T, Christofidou E, Koumantaki E. Should novel psoriasiform eruptions be considered a paraneoplastic sign of invasion in patients with breast cancer? J Eur Acad Dermatol Venereol 2007; 21:285-6. [PMID: 17243989 DOI: 10.1111/j.1468-3083.2006.01859.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- J-N Dauendorffer
- Service de Dermatologie, Centre hospitalier F. Quesnay 2, boulevard Sully, 78200 Mantes-la-Jolie Cedex
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Rajagolalan M. Skin as a Mirror of Internal Disease. APOLLO MEDICINE 2006. [DOI: 10.1016/s0976-0016(11)60211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Strobel ES, Bouveret C, Kohl PK. Acrokeratosis paraneoplastica of Bazex as an indicator for underlying squamous cell carcinoma of the lung. J Cancer Res Clin Oncol 2006; 132:376-8. [PMID: 16435144 DOI: 10.1007/s00432-006-0078-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 01/04/2006] [Indexed: 10/25/2022]
Abstract
PURPOSE Obligatory cutaneous paraneoplastic disorders comprising acanthosis nigricans maligna, erythema gyratum repens, paraneoplastic pemphigus, hypertrichosis lanuginosa acquisita, erythema necrolyticum migrans and acrokeratosis paraneoplastica are rare. However, as markers of an underlying internal malignancy they are of utmost importance for the patient. Acrokeratosis paraneoplastica (first described by Gougerot and Rupp in 1922) was named after Bazex who had then reported several cases in a French dermatological journal since 1965 (Bazex et al. in Bull Soc Fr Dermatol Syphiligr 72:182, 1965; Bazex and Griffiths in Br J Dermatol 102:301-306, 1980). METHOD The study is a clinical case of a patient with acrokeratosis paraneoplastica. RESULTS the patient was later diagnosed with a cervical lymph node metastasis and thereafter with a primary squamous cell carcinoma of the left upper lobe and upon treatment responded with the clearing of the skin changes. CONCLUSION Identification of a paraneoplastic syndrome may enhance the earlier diagnosis of the associated tumor and may thus enable curative treatment.
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Affiliation(s)
- Eva-Susanne Strobel
- Division of Hematology and Oncology, St. Georg Vorsorge- und Rehabilitationskliniken, Kurhausplatz 1, 79862 Höchenschwand, Germany.
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