Cancer and the skin

Question 1

List the dermatoses with a strong association with cancer

Answer 1

1/ Acquired Hypertrichosis Lanuginosa
2/ AESOP syndrome
3/ BASEX syndrome
4/ Carcinoid Syndrome
5/ Ectopic ACTH syndrome
6/ Erythema gyratum repens
7/ Glucogonoma syndrome
8/ Paraneoplastic pemphigus

Question 2

What is this condition? What is the association?

Answer 2

Paraneoplastic hypertirchosis Langinosa Acquisita

Ass with a poor prognosis (metastatic CRC > Lung > breast)

Also ass with acanthosis nigricans, tongue papillae hypertrophy and altered taste and smell

Question 3

What is this condition? what are the associations?

Answer 3

Erythema gyratum repens

• A migratory erythema with mobile concentric “wood grain” pattern
• Migrates ~ 1 cm per day
• Pruritic
• Trailing collarette of scale

80% are associated with an internal malignancy

Lung > oesophagus > breast > GIT

M > F

Question 4

What condition is this?

Answer 4

Bazex syndrome - Acrokeratosis paraneoplastica

• usually begins with scaling dermatosis of the fingers and toes that may quickly spread to the nails.
• Severely abnormal nails with painful paronychia
• Scaly eruptions on the external ears that may progress to involve the cheeks and nose
• Diffuse thickening and scaling of the palms and soles (keratoderma), with a peculiar honeycomb appearance
• Eventually, the skin disease may spread to involve trunk, limbs and scalp
• Some patients are itchy

Ass. with SCC of the upper respiratory tract or GIT

Question 5

What is carcinoid Syndrome?

Answer 5

A paraneoplastic syndrome.

Due to the release of peptides and amines (serotonin, histamine etc) from an advanced neuroendocrine tumour

(gut&raquo_space; pancreas, kidney, ovaries, testes)

Sx:
- flushing (face, head, neck, chest, epigastric areas +/- mottling and secondary telangectasias)
- diarrhoea
- wheezing
- Pellagra (niacin deficency: dermatitis, dementia, diarrhoea)

Dx:
- elevated 24hr urine 5-hydroxyindoleacetic acid (5 - HIAA) which measures serotonin production

Question 6

What is necrolytic migratory erythema?

Answer 6

a characteristic rash usually occurring in the glucagonoma syndrome

may affect any site but it most often affects the genital and anal region, the buttocks, groin and lower legs.

The rash fluctuates in severity. Initially there is a ring-shaped red area that blisters, erodes and crusts over.

It can be quite itchy and painful.
PIH is common

Question 7

What are the features of glucogonoma syndrome?

Answer 7

Cutaneous:
- Necrolytic migratory eryhtema
- Annular Chelitis
- Glossitis

Systemic:
- weight loss
- diabetes mellitus
- anemia

Question 8

What are tripe palms?

Answer 8

Ridged velvety lesions on the palms

Often ass with acanthosis nigricans.
Often ass with GIT cancer (gastric adenocarcinoma > lung > breast)

Question 9

What is ectopic ACTH syndrome?

Answer 9

A paraneoplastic syndrome
Due to ectopic ACTH

Results in hyperpigmentation and features of cushings syndrome

Ass Ca = carcinoid, small cell tumours of the lungs, pancreatic island cell cancers etc