Cutaneous Markers Of Internal Malignancy Research Articles

A clinic epidemiological study of cutaneous markers of internal malignancy

<p class="abstract"><strong>Background:</strong> The skin provides important clues to many systemic diseases. Changes in the skin can be a marker for internal malignancies. If any cutaneous disorder associated with malignancy can be recognized early, it paves way to rapid diagnosis and treatment of the underlying malignancy. we made such an attempt to recognize cutaneous disorders in 40 patients suffering with internal malignancies at government general hospital, Guntur attending dermatology and radiology departments.</p><p class="abstract"><strong>Methods:</strong> Patients with internal malignancy having specific features were included in our study. Biopsy was done in every patient. The present study lasted for 21 months i.e., from January 2008 to September 2009.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that carcinoma cervix was the most common malignancy in females and bronchogenic carcinoma in males associated with cutaneous markers. The markers observed were pruritus, acquired lymphorroids, para neoplastic pemphigus, acquired icthyosis and disseminated granuloma annulare. Cutaneous markers were observed within 6 months from onset of internal malignancies.</p><p class="abstract"><strong>Conclusions:</strong> Recognition of any para-neoplastic skin disorders should raise suspicion for an internal malignancy which helps in rapid diagnosis and treatment of underlying malignancy.</p>

Are All Seborrheic Keratoses Benign? Review of the Typical Lesion and Its Variants

Seborrheic keratosis (SK) is one of the more common benign epidermal neoplasms seen in adult and middle-aged patients. As little is written in the literature about the variants of SK, this article aims to categorize and discuss the different subtypes and their important associations. An in-depth literature search using OVID Medline and PubMed was conducted to classify the various subtypes of SK. Clinical variants were photographed and used to help document the subtypes. The pathology is described for each. Six subtypes of SK were identified: dermatosis papulosa nigra, stucco keratosis, inverted follicular keratosis, large cell acanthoma, lichenoid keratosis, and flat seborrheic keratosis. Although the etiology and pathogenesis of SKs are still largely debatable, several underlying mechanisms and contributing factors have been identified. All subtypes represent benign lesions, and treatment is usually done for cosmetic reasons. Several of the subtypes may act as cutaneous markers for internal malignancy and should be monitored closely for any atypical changes. Although all subtypes of SK are benign, their association with other malignant lesions and ability to serve as cutaneous markers of internal malignancy emphasize the importance of correctly identifying all variants.

Cutaneous markers of internal malignancy. II. Paraneoplastic dermatoses and environmental carcinogens

A variety of cutaneous disorders may reflect the presence of an internal disease. The ability to recognize those that may indicate an underlying malignancy is of particular importance. In part I of this series malignant involvement of the skin, either direct or metastatic, and the genodermatoses with malignant potential were reviewed. In this portion, we describe the paraneoplastic dermatoses as well as the cutaneous effects of some environmental carcinogens associated with internal malignancy. In addition, several uncommon and controversial associations between benign dermatoses and internal malignant disease will be discussed.

Cutaneous markers of internal malignancy. I. Malignant involvement of the skin and the genodermatoses

Cutaneous findings often reflect the presence and course of an internal disease. Recognition of external clues is important to facilitate both early diagnosis and prompt treatment of the internal disorder. Early recognition is especially valuable in a patient with an internal malignant disease because intervention may significantly affect survival. In this two-part series, we review the spectrum of cutaneous markers of internal malignancy. Part I focuses on malignant involvement of the skin caused by either direct extension or metastases and the genodermatoses with malignant potential. Part II will be devoted to the paraneoplastic skin manifestations of internal malignancy as well as environmental carcinogens that produce cutaneous features. We also discuss some proposed but controversial associations between skin disease and internal malignancy.

Seborrheic keratoses and cancer

The eruptive appearance of numerous seborrheic keratoses, the sign of Leser-Trélat, has been regarded as a reliable cutaneous marker of internal malignancy. We have evaluated the possible association of malignant disease and the sign in 1752 consecutive cases of seborrheic keratoses. First, the Swedish Cancer Registry was searched for records of malignancies in the study population (1958 to 1984), and the expected number of malignancies was calculated. Second, records of persons with malignancy within 1 year before or after the diagnosis of seborrheic keratosis were checked for the sign of Leser-Trélat. Third, a case control study was performed to evaluate the possibility of eruptive seborrheic keratoses among the noncancer patients in the study population. The results showed a slight increased risk of cancer in the study population (relative risk = 1.2; 95% confidence interval = 1.0 to 1.3), mainly because of an increased risk of cutaneous squamous cell carcinoma. In 62 patients with seborrheic keratoses, a malignancy (excluding skin) was diagnosed within 1 year before or after the diagnosis of seborrheic keratosis. Of these 62 patients, 6 were regarded as possibly having presented with the sign of Leser-Trélat. For every one of the 62 cases with seborrheic keratosis and malignancy within one year, an age- and sex-matched control patient without cancer was selected from the study population and the records were checked for sudden and eruptive seborrheic keratoses. Among the control patients, five were regarded as possibly having presented with the sign of Leser-Trélat. This study gives no evidence to support the opinion that eruptive seborrheic keratoses are related to internal cancer risk.

The sign of Leser-Trélat: Does it exist?

The sign of Leser-Trélat is usually regarded as a reliable cutaneous marker of internal malignancy. We have reviewed the literature and conclude that the evidence for a causal relation between eruptive seborrheic keratoses and cancer is meager.

Acute neutrophilic dermatosis with diffuse histiocytic lymphoma

We report an elderly man with acute neutrophilic dermatosis (AND) associated with a diffuse histiocytic lymphoma. This cutaneous marker of internal malignancy is usually associated with myeloproliferative disorders. To our knowledge this case is the first linkage of AND with this type of lymphoma.

Multiple Telangiectases Preceding the Appearance of Undifferentiated Bronchogenic Carcinoma

A patient with undifferentiated bronchogenic carcinoma, which was preceded by skin manifestations, namely telangiectases on the palms, soles, fingers, toes, lips and tongue, is described. It is possible that these multiple vascular lesions are one of the cutaneous markers of internal malignancy.

Breast carcinoma and basal cell epithelia after X-ray therapy for hirsutism

We report a 60-year-old woman with a history of x-ray therapy for generalized hirsutism at 20 years of age who at the age of 37 years developed the first of numerous basal cell epitheliomas on her trunk, including chest, on a background of radiation damaged skin. At the age of 51 years one of the basal cell epitheliomas was biopsied and an incidental histologic finding was a breast carcinoma. The basal cell epithelioma is clearly linked with x-ray exposure; breast cancer is less so although there is impressive epidemiologic evidence supporting an association between human breast cancer and radiation exposure. In view of an association between thyroid cancer and dermatologic x-ray therapy, further investigation of such an association with breast cancer should be considered. It may be wise to evaluate patients who received dermatologic x-ray exposure to their breasts for possible breast cancer and to consider radiation induced skin damage on or near the skin overlying the thyroid or breasts as a cutaneous marker of internal malignancy or potential internal malignancy.

Leser-Trélat Associated With Acute Leukemia

To the Editor.— The sign of Leser-Trelat is just one of a number of cutaneous markers of internal malignancy and refers to the sudden appearance of a large number of seborrheal keratoses in association with the development of cancer. 1 Not only does one see an increase in number of keratoses, but preexisting lesions seem to increase in size in just a matter of days. The significance of the association has been questioned because the incidence of cancer as well as seborrheal keratoses is high in the elderly and, generally, it is the older patient who develops this sign. 2 However, the clinical situation can develop so dramatically that one must consider that this association of internal malignancy with the appearance of these benign cutaneous lesions is real and statistically significant. We would like to report such a patient who made believers out of skeptics. The majority of patients exhibiting