Bazex Syndrome Associated with Squamous Cell Carcinoma of the Lip: A Rare Paraneoplastic Acrokeratosis with Nail Dystrophy

Abstract

Introduction: Acrokeratosis paraneoplastica of Bazex (APB) is a rare paraneoplastic dermatosis having definite association with malignancy, most commonly squamous cell carcinomas (SCC) of the upper aerodigestive tract. It is characterized by psoriasiform plaques involving the ears, nose, hands, and feet. Nail changes are commonly encountered, including onychauxis, subungual hyperkeratosis, xanthonychia, onycholysis, and onychorrhexis. Case Presentation: We report the details of a 40-year-old male who presented with cutaneous changes involving both ears, palms, and soles and multiple nails, suggestive of APB. These typical changes were succeeded by an SCC of the lip. Discussion/Conclusions: In 70% cases of APB, nail changes precede the diagnosis of the underlying neoplasm by up to 10 months, offering a good lead-time for early suspicion of malignancy. Our case highlights the importance of recognizing these changes early. An atypical location of malignancy (lower lip) and rare presentations, including painful acrokeratosis, melanonychia striata, and chloronychia, as seen in our case, should also be kept in mind.