A palmar dermatosis linked to occult carcinoma of the upper thorax, head and neck: Bazex's syndrome and tripe palm

Abstract

An unusual, persistent, corregated-to-honeycombed thickening of the palms accompanied by tenderness around the fingernails was found to be a cutaneous marker for internal malignancy. This combination of signs and symptoms has been reported under two clinical entities: Bazex's syndrome and tripe palm. This paraneoplastic syndrome is of interest to head and neck surgeons due to the location of the primary tumor, the site of metastatic disease, and the ability to cure the cutaneous disease by surgical removal of the primary tumor. In our patient, a squamous cell carcinoma of the lung not detectable on chest x-ray presented as a cervical mass accompanied by cutaneous changes on the palms and fingernails. Recognition of the relationship of the dermatologic changes to malignancy of a specific body region eventually led to the detection of the primary tumor. The characteristics of these paraneoplastic syndromes were reviewed in this report.

Paraneoplastic acrokeratosis of Bazex (Bazex's syndrome): Report of a female case associated with cholangiocarcinoma and review of the published work

“…The diagnosis is based on clinical features and non‐specific histology 28 . Although there are exceptions, 10,29 the lack of a complete response to dermatological treatment is a characteristic feature that supports the diagnosis of PAB 3–8,23,28 . The differential diagnosis of PAB includes: psoriasis, seborrheic dermatitis, rosacea, lupus erythematosus, tinea, palmoplantar keratodermas, syphilis, mycosis fungoides and pityriasis rubra pilaris 3,6,7,10,23,29,30 …”

“…3,6,7,22 Less commonly, lesions may be pruritic, edematous, hyperpigmented, hypopigmented, crusty or bullous. 3,10,[19][20][21][22][23] Typical nail changes include flattening of the nail plate, onycholysis, subungual keratotic debris, yellow discoloration, ridging and bands of discoloration. 3,5,[23][24][25][26] The eruption evolves in three stages.…”

“…3,10,[19][20][21][22][23] Typical nail changes include flattening of the nail plate, onycholysis, subungual keratotic debris, yellow discoloration, ridging and bands of discoloration. 3,5,[23][24][25][26] The eruption evolves in three stages. 3,4 In the first stage, initial sites of predilection are acral (hence the term acrokeratosis), and include the fingers/toes, soon spreading to the nose and ears.…”

“…28 Although there are exceptions, 10,29 the lack of a complete response to dermatological treatment is a characteristic feature that supports the diagnosis of PAB. [3][4][5][6][7][8]23,28 The differential diagnosis of PAB includes: psoriasis, seborrheic dermatitis, rosacea, lupus erythematosus, tinea, palmoplantar keratodermas, syphilis, mycosis fungoides and pityriasis rubra pilaris. 3,6,7,10,23,29,30 Common dermatological treatments (corticosteroids, tar, vitamin D 3 , keratolytics, emmolients, antibiotics, antifungals, etretinate, ultraviolet [UV]B irradiation) are generally unsuccessful but retinoids and psoralen plus ultraviolet A (PUVA) might be tried.…”

Bazex syndrome (acrokeratosis paraneoplastica)

“…To date, a total number of 112 cases have been described [1-20, 21-36, 37-72, 73-93]. Although the skin eruptions in acrokeratosis paraneoplastica (now known as Bazex syndrome) are usually associated with carcinomas of the head and neck, to our knowledge there have appeared only a few reports in the French, American and German otolaryngologic literature [15,39,46,57,59,63,66,69,79]. This is unusual for a rare but distinctive disease in clinical otolaryngology and dermatology.…”