Cutaneous manifestations of cancer

The biology of human hair greying

Hair greying (canities) is one of the earliest, most visible ageing-associated phenomena, whose modulation by genetic, psychoemotional, oxidative, senescence-associated, metabolic and nutritional factors has long attracted skin biologists, dermatologists, and industry. Greying is of profound psychological and commercial relevance in increasingly ageing populations. In addition, the onset and perpetuation of defective melanin production in the human anagen hair follicle pigmentary unit (HFPU) provides a superb model for interrogating the molecular mechanisms of ageing in a complex human mini-organ, and greying-associated defects in bulge melanocyte stem cells (MSCs) represent an intriguing system of neural crest-derived stem cell senescence. Here, we emphasize that human greying invariably begins with the gradual decline in melanogenesis, including reduced tyrosinase activity, defective melanosome transfer and apoptosis of HFPU melanocytes, and is thus a primary event of the anagen hair bulb, not the bulge. Eventually, the bulge MSC pool becomes depleted as well, at which stage greying becomes largely irreversible. There is still no universally accepted model of human hair greying, and the extent of genetic contributions to greying remains unclear. However, oxidative damage likely is a crucial driver of greying via its disruption of HFPU melanocyte survival, MSC maintenance, and of the enzymatic apparatus of melanogenesis itself. While neuroendocrine factors [e.g. alpha melanocyte-stimulating hormone (α-MSH), adrenocorticotropic hormone (ACTH), ß-endorphin, corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone (TRH)], and micropthalmia-associated transcription factor (MITF) are well-known regulators of human hair follicle melanocytes and melanogenesis, how exactly these and other factors [e.g. thyroid hormones, hepatocyte growth factor (HGF), P-cadherin, peripheral clock activity] modulate greying requires more detailed study. Other important open questions include how HFPU melanocytes age intrinsically, how psychoemotional stress impacts this process, and how current insights into the gerontobiology of the human HFPU can best be translated into retardation or reversal of greying.

Non-Specific Onset of Pulmonary Adenocarcinoma

Skin metastases are rarely found in lung cancer compared to other types of neoplasia. Of the types of lung cancer that can have skin metastases, the most common one is adenocarcinoma. Pulmonary cancer metastasizing to the skin has poor prognosis, usually the survival rate of the patients is 4-6 months. We present the case of a 59-year-old woman, smoker, high blood pressure, dyslipidemia, with two skin ertitemato-nodular lesions, incompletely delimited, with a diameter of 4-5cm, in the left arm (1/3 medio-external) and left latero-thoracic (near IV intercostal space) area, discovered during a regular medical examination at her family doctor’s practice. After multiple clinical and paraclinical investigations, almost 3 months after the initial presentation, the patient was diagnosed with stage IV pulmonary adenocarcinoma with supra and subdiaphragmatic lymph-node metastases, soft tissue metastases, liver metastases and breast metastases. Oncological treatment was initiated, but the patient's progression was unfavorable, her passing occurring 6 months after being diagnosed.

Self-assembled multi-ring formations of glutamine and a possible link to erythema gyratum repens

In the body L-glutamine is abundant and required for the proliferation of cells. Indeed human physiology is dependent upon having and maintaining the correct glutamine levels for a range of functions including neurological signalling and a healthy immune system. However, during tumourigenesis cell proliferation demands elevated levels of glutamine, which can ultimately lead to muscle atrophy. In some cases the skin provides the first indications of the underlying disease and erupts in a wave of complicated pattern formations. One such skin marker is erythema gyratum repens. We investigated the pattern formations associated with concentrations of glutamine in aqueous solutions at levels higher than that of a normal biological functionality. We find remarkable similarities between the patterns of erythema gyratum repens and the unusual self-assembled patterns of glutamine. The findings may lead to new therapeutics and understanding for those working in oncology and toxicology. Utilising the formations associated with glutamine could also assist in bio-functionalising micro and nanoparticles for high efficacy.

Primary and metastatic malignant tumors of the scalp: an update

In recent years there have been a number of interesting advances in several topics relating to the diagnosis and treatment of cutaneous lesions with particular applicability to primary and metastatic malignancies of the scalp. In this article we provide a general update of advances in this field, and cover the more salient points relating to a variety of malignant tumors that have been reported to appear on the scalp as primary or metastatic lesions. A search and review of the literature on PubMed was made to identify and discuss relevant points relating to diagnosis and treatment of primary and metastatic tumors of the scalp. We describe the anatomy of the scalp, epidemiology of scalp tumors, theories of field cancerization and field therapy, photodynamic therapy, excisional surgical techniques and reconstruction, lymphoscintigraphy, chemoprevention, as well as details relating to atypical fibroxanthoma, Brooke-Spiegler syndrome, nevus sebaceus, cutaneous lymphoma, and metastatic disease. There is a very broad differential diagnosis for scalp nodules, which includes many different benign and malignant diseases, and treatment should be tailored accordingly. Given the potential for poor prognosis with some of the more aggressive malignancies that can be found in this anatomic area, the importance of a thorough physical examination cannot be emphasized enough, and early detection is critical to provide patients with the best chance for a favorable outcome.

Acanthosis nigricans in a patient with lung cancer: a case report

Some skin lesions may accompany malignancies. Acanthosis nigricans, one such lesion, is a paraneoplastic dermatosis characterized by hyperpigmented and velvety verrucose plaques observed as symetric eruptions. With this report, we aim to present a rare case of concomitant lung cancer and acanthosis nigricans. Malignant acanthosis nigricans is most commonly associated with intra-abdominal malignancies. A 65-year-old patient who had hyperpigmented, hypertrophic and symmetric verrucose lesions at the flexor surfaces of the lower and upper extremities, face, palms and the axillary region. Thoracic computed tomography demonstrated a hypodense mass lesion with a dimension of 5 × 5.5 cm at the center of basal segment bronchi of the left pulmonary lobe. Fiberoptic bronchoscopy showed that the access to the lower left lobe was almost completely obstructed by the endobronchial lesion. The result of the histopathologic examination of the endobronchial tissue biopsy was reported as non-small cell (adenocarcinoma) lung cancer. Result of the histopathologic analysis of the punch biopsy of the skin lesions was reported as acanthosis nigricans .There are no pathognomonic dermatological findings for lung cancer. In conclusion, there are skin lesions that accompany lung cancer and we believe that these should be considered for differential diagnosis.

Acanthosis nigricans in the head and neck region

Background:

The sudden appearance of acanthosis nigricans on the skin of an individual is highly suggestive of an underlying clinical disease. However, there is no information on its possible association with head and neck disease in our environment.

Objective:

To determine the prevalence of acanthosis nigricans and identifying the underlying associated medical and oncologic factor in an Otorhinolaryngologic, head and neck practice.

Method:

This was a 12-month prospective study of patients seen at Otorhinolaryngology department of University College Hospital, Ibadan. Relevant clinical, anthropometric and biochemical information were obtained with an interviewer assisted questionnaire and data analyzed using descriptive statistics.

Results:

Of 764 patients, 85(11.13%) had head and neck malignancies, 15(1.96%) had diabetes mellitus in addition to the Otorhinolaryngologic, head and neck diseases. The body mass index values for male and female ranged from 18.26 – 25.68kg/m² and 17.94 – 30.25kg/m² respectively. Only two patients, one with nasopharyngeal cancer and the other with obesity in addition to chronic rhinosinusitis had acanthosis nigricans.

Conclusion:

Acanthosis nigricans is not common among Otorhinolaryngologic patients in our clinical setting with a prevalence of 0.003. Nevertheless, its presence should herald the suspicion of an underlying metabolic or oncologic disease.

Atypical cutaneous lymphoid hyperplasia induced by chemotherapy in a patient with advanced colon carcinoma

Some conditions are predisposed to excessive lymphocyte responses, which can progress to a benign condition, ie, atypical cutaneous lymphoid hyperplasia (ACLH), or a malignant lymphoma. Clinical diagnosis of drug-associated pseudolymphoma can be based on a temporal association between drug ingestion and lesion onset followed by resolution without recurrence after discontinuation of drug administration. Herein, we report the case of a 66-year-old man with advanced colon carcinoma with ACLH developed while receiving chemotherapy regimen with oxaliplatin/5-fluorouracil/leucovorin. The authors postulate that chemotherapy can promote an aberrant immune response to an antigen that can be the drug itself or other self-antigens.

Tumor invasion of the skin

This article discusses several solid organ and hematologic neoplasms that can metastasize to the skin. Special emphasis is placed on the most frequent solid and hematological malignancies that have cutaneous metastases, including breast cancer, melanoma, lung cancer, colon cancer, and leukemia. In addition, mammary and extramammary Paget's disease are further discussed as examples of direct extension of primary tumors to the skin.

Skin findings in internal malignant diseases

PURPOSE

A skin finding may be an indicator of internal malignant diseases. In this report, we investigated the skin findings of the cases who have had internal malignancy within the last 1 month.

PATIENTS AND METHODS

Seven hundred cases who were diagnosed as internal malignancy and who did not have any treatment for the malignancy were enrolled in our study between February 2002 and September 2003. A form was completed for all of the cases, including name, surname, and the carcinoma type. All cases were examined in detail, and the observed skin findings or dermatosis was recorded.

RESULTS

The most frequent skin findings among the cases were tinea pedis/onychomycosis, followed by xerosis and pruritus. The skin findings in terms of frequency were determined mostly in hematological malignancies (68.96%).

CONCLUSION

We would like to emphasize that the skin is an indicator of the functions of internal organs and their disorders.

Clinical and pathologic findings of paraneoplastic dermatoses

Paraneoplastic dermatoses comprise a heterogeneous group of noninherited skin conditions that manifest internal malignancy. Familiarity with paraneoplastic dermatoses is important to both clinician and pathologist alike, as recognition of such a condition offers opportunity for early diagnosis and treatment of internal malignancy; monitoring for tumor recurrence; and insight into pathophysiology which may yield possible clues to treatment. Herein are reviewed 16 of the best established paraneoplastic dermatoses that display distinctive clinical and pathologic findings.

LEARNING OBJECTIVE

At the conclusion of this leaning activity, participants should be able to recognize, diagnose, and describe the clinical and pathologic findings of paraneoplastic dermatoses.

Isolated Xanthoma of the Frontal Bone

Xanthomas of soft tissue are common, well described lesions. Much less common are xanthomas of bone. Rarer still are xanthomas of the bones of the skull or facial skeleton. The case of a woman with an incidentally found isolated xanthoma of the frontal bone in the setting of normal blood lipid levels is reported. Surgical treatment of such lesions is both diagnostic, in excluding other lesions such as eosinophilic granuloma, and therapeutic.

Cutaneous paraneoplastic syndromes in dogs and cats: a review of the literature

Cutaneous paraneoplastic syndromes are a group of noncancerous dermatoses associated with internal malignancy. Their recognition can facilitate detection and timely treatment of underlying cancer. More than 30 such disorders have been identified in the human scientific literature, whereas only a few are described in veterinary medicine. This may reflect a lower incidence in animals than in people or may be the result of failure to recognize an association between certain skin lesions and neoplasia. Establishing a relationship between a cutaneous disorder and neoplasia can be difficult unless the skin lesions are rare and almost always associated with a particular tumour type, as is the case for most recognized veterinary paraneoplastic dermatoses. Among these are feline paraneoplastic alopecia, feline thymoma-associated exfoliative dermatitis, nodular dermatofibrosis, feminization syndrome associated with testicular tumours, superficial necrolytic dermatitis and paraneoplastic pemphigus. The aetiology of most cutaneous paraneoplastic syndromes has remained elusive in both people and animals.