SKIN MARKERS OF MALIGNANT DISEASE

Some skin disorders are precipitated by an underlying malignancy and others almost always indicative a visceral neoplasm. Early recognition may assist detection of the underlying neoplastic disease.

Disorders with a strong association with underlying malignancy:

1)    NECROLYTIC MIGRATORY ERYTHEMA:

This is usually caused by a tumour of the pancreatic islet alpha cells that secrete glucagon, but it is sometimes caused by hyperplasia or benign adenomatosis of these cells. Rarely no underlying abnormality can be found. Areas of erythema, which becomes eroded and crusted, develop around the groins, on the lower trunk, around the flexures and at the sides of the mouth. They may temporarily remit at one site, to appear elsewhere. The skin disorder responds to removal of the underlying tumour, but usually complete removal is not possible.

Characteristically, there is degenerative change in the upper dermis. Blood tests reveal increased circulating glucagon, hyperglycemia and hypoaminoacidaemia and it is the last of these that may be responsible for this curious skin disorder.

2)   ACANTHOSIS NIGRICANS:

Acanthosis nigricans may occur in association with endocrine disease and also, rarely, accompanies lipodystrophies. An identical clinical picture accompanies obesity and is then known as pseudo acanthosis nigricans.When the condition occurs in an adult unaccompanied by obesity or endocrine disease, an underlying neoplasm is usually the cause. The neoplasm involved is often a gastrointestinal adenocarcinoma.

There is a velvety thickening and increased rugosity of the skin of the flexures- the axilla and groin in particular. The sides and back of the neck and the sides of the mouth are also affected.

The thickened areas are also pigmented and bear skin tags and seborrhoeic warts. There may also be some generalized increase in pigmentation, as well as thickening and increased rugosity of the buccal mucosa and the palmar skin.

There is overall hypertrophy of all components of the skin of the affected areas. Insulin- like growth factors may be involved.

3)    ERYTHEMA GYRATUM REPENS:

This is probably the rarest of the specific markers of visceral malignancy. This odd disorder is almost always a marker of a neoplasm, often carcinoma of the bronchus.

Large rings composed of reddened polycyclic bands are seen; the rings contain concentric rings; giving a wood-grain effect. The rings gradually enlarge and change shape. Rarely, other dramatic types of annular erythema may be signs of an internal malignancy.

4)   SKIN METASTASES:

Carcinomas of the breast, bronchus, stomach, kidney and prostate are the most common visceral neoplasms to metastasize to the skin. Secondary deposits on the skin may be the first sign of the underlying visceral cancer. The lesion themselves are usually smooth nodules, which are pink or smooth colored, but may be pigmented in deposits of melanoma.

5)    ACQUIRED ICHTHYOSIS:

When generally scaling without erythema begins in adult life, it is quite likely that there is an underlying neoplasm, particularly in reticulosis. This has to be distinguished from mild dryness of the skin and the slight irritation seen in many chronic disorders, known as xeroderma.

Other causes of acquired ichthyosis include AIDS, sarcoidosis and leprosy, but if these can be excluded, a neoplastic cause is the most likely explanation.     

Disorders that are sometimes associated with underlying malignancy:

1)   BULLOUS PEMPHIGOID:

This subepidermal blistering disorder occurs mainly in those over 60 years of age, who are anyway more likely to be affected by a neoplasm. Nonetheless,there are a few patients with pemphigoid in whom the skin disorder is provoked by the malignancy and remits after the neoplasm has been removed.

2)   DERMATOMYOSITIS:

Women over the age of 40 years with dermatomyositis may have 50% chance of malignant tumour of the genitourinary tract, but infants with the disease have no greater risk than a control group. Overall, even in adults, the association is not common and most cases of dermatomyositis occur without an identifiable cause. There is an impression that dermatomyositis provoked by malignant disease is more severe.

3)   FIGURATE ERYTHEMA:

Rarely, annular erythema and erythema multiforme seem to be caused by underlying malignant disease.

BY:

  DR CHETAN LALSETA

                                   M.D.(Skin & V .D)

    DERMATOLOGIST & COSMETOLOGIST

    “C POINT”—A UNIT OF MCSPL

     SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,

     RAJKOT-360005

     www.cpoint.in

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