Skin and systemic disease

Question 1

What are skin signs associated with?

Answer 1

• Disease in pretty much every organ system/ specialty
• Underlying cancer
• Metastasis or paraneoplasia
• Multisystem autoinflammatory and deposition diseases
• Cutaneous side effects from treatments

Question 2

What skin conditions hint at underlying cancer in most/ all cases?

Answer 2

• Carcinoid Syndrome
• Paraneoplastic pemphigus
• Erythema Gyratum Repens
• Acquired hypertrichosis
• Leser Trelat
• Bazex Syndrome
• Ectopic ACTH
• Pagets Disease

Question 3

Explain carcinoid syndrome

Answer 3

• Episodic flushing, mins -hours
• No sweating
• Facial telangiectasia
• GI carcinoid = liver mets
• Bronchial, ovarian = can occur with no liver mets

Question 4

What is paraneoplastic pemphigus?

Answer 4

• Erosive stomatitis, rash

- Non-hodgkin’s, Castleman’s disease (produces the autoantibody)

Question 5

What is erythema gyratum repens?

Answer 5

• Concentric erythematous lesions

- Variable sites & types of malignancy

Question 6

What is acquired hypertrichosis lanuginosa?

Answer 6

• Acute onset of lanugo hairs at face & body

- Colorectal ca > lung > breast, usually advanced

Question 7

What is leser trelat?

Answer 7

• Eruptive seborrhoeic keratoses

- GI adenocarcinomas

Question 8

What is Bazex syndrome?

Answer 8

• Hyperkeratosis of extremities
• Resembles psoriasis, non-specific fx on skin biopsy
• SCC: bronchial, oropharyngeal, GI
• Gastric, colon, biliary adenocarcinomas

Question 9

What is ectopic ACTH syndrome?

Answer 9

• Tumour production of ACTH leads to generalised hyperpigmentation
• ACTH -> Inc. MSH -> release of melanin from melanocytes

Question 10

What is paget’s disease?

Answer 10

• Eczematous plaque at nipple / areola

- Extension of underlying ductal adenocarcinoma

Question 11

What is extramammary paget’s?

Answer 11

• Primary intraepithelial adenocarcinoma (>75%)

- Secondary to underlying visceral tumour: bladder, colon

Question 12

What skin conditions are strongly associated with cancer?

Answer 12

• Acanthosis Nigricans

- Dermatomyositis

Question 13

What is acanthosis nigricans?

Answer 13

Can preceed malignancy (gastric adenocarcinoma). ?related to by-products. Concern if:

• Older patient, rapid onset
• Other skin signs
• Involves lips
• Weight loss

Question 14

What is dermatomyositis?

Answer 14

• Inflammatory myopathy + rash
• Periorbital heliotrope rash
• Gottron’s papules: red maculo-papular lesions over bony prominences
• Shawl sign
• Photosensitive poikiloderma
• Scalp erythema

Question 15

What skin conditions may be associated with malignancy?

Answer 15

• Bullous pemphigoid
• Sweets Syndrome
• Pyoderma gangrenosum
• Acquired ichthyosis
• Acquired angioedema
• Primary systemic amyloid
• Cryoglobulinemia

Question 16

Give examples of eponymous syndromes

Answer 16

• Peutz-Jeghers: melanosis, colon hamartomas, colon ca
• Muir-Torre: sebaceous tumours, keratoacanthomas, GI, breast, GU
• Neurofibromatosis: Café au lait, Ax freckles, Neurofibromas, nerve sheath, phaeoCCyT, carcinoid
• MEN syndromes: angiofibromas, neuromas, lichen or macular amyloid (MEN2), endocrine, P’s
• Xeroderma pigmentosum: inability to repair sun damage, sarcoma, leukaemia, GI, lung
• Howel-Evans: palmoplantar keratoderma, oesophageal

Question 17

What skin signs point to genetic GI disease?

Answer 17

• Hereditary hemorrhagic telangiectasia
• Ehlers danlos (collagen)
• Pseudoxanthoma elasticum (elastic)
• Blue rubber bleb naevus
  - > GI haemorrhage

Question 18

What skin conditions point to inflammatory/ autoimmune GI disease?

Answer 18

- Malignant atrophic papulosis (degos disease)
        > GI haemorrhage
- Erythema nodosum
- Pyoderma gangrenosum
        > IBD

Question 19

What are the skin signs of diabetes

Answer 19

• Acanthosis nigricans
• Acral erythema
• Carotenemia
• Diabetic bullae
• Diabetic dermopathy
• Disseminated granuloma annulare
• Eruptive xanthomas
• Necrobiosis lipoidica
• Rubeosis
• Scleredema