Cutaneous Manifestations of Internal Malignancy

Abstract

The skin often mirrors changes in the organism it envelops. Many neoplastic diseases that affect internal organs display cutaneous manifestations, which may be the presenting signs and symptoms of the underlying malignancy. These may reflect direct involvement of the skin by the tumor (ie, tumor metastasis) or indirect involvement, in which changes in the skin occur in the absence of malignant cells. This review focuses on the latter conditions, which are often referred to as paraneoplastic dermatoses. Included in the discussion are the cutaneous manifestations of inherited syndromes that are associated with an increased risk of internal malignancy, cutaneous changes in patients with hormone-secreting tumors, and the wide spectrum of proliferative and inflammatory dermatoses that have been associated with internal cancer. CA Cancer J Clin 2009;59:73-98.

Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment

“…104 Approximately 10% to 25% of cases are paraneoplastic. 100,105,133 Commonly associated malignancies include breast, ovarian, lung, and prostate cancer, 100 but it is not clear if this association merely reflects cancer prevalence in at-risk populations. 105 The diagnosis of dermatomyositis is suggested by an elevated level of creatine phosphokinase (which may be followed to monitor response to therapy), characteristic findings on electromyography, and muscle biopsy findings demonstrating a mixed B-and T-cell perivascular inflammatory infiltrate and perifascicular muscle fiber atrophy.…”

“…102 dermatomyoSItIS Dermatomyositis is an inflammatory myopathy featuring multiple skin changes before the onset of proximal muscle weakness. 100,104 Classically, dermatologic findings include a heliotrope rash (so-named for the purplish color of the heliotrope plant) on the upper eyelids; an erythematous rash on the face, neck, back, chest, and shoulders; and Gottron papules, a scaly eruption over the phalangeal joints that may mimic psoriasis. 104 Approximately 10% to 25% of cases are paraneoplastic.…”

“…Among paraneoplastic cases, gastric adenocarcinoma is the most commonly associated malignancy. 100 Up to 90% of cases of acanthosis nigricans of the palms, termed tripe palms, have been found to be cancer-associated. 102 Paraneoplastic acanthosis tends to be more severe than the benign condition.…”

“…134 Glucocorticoids are the mainstay of treatment for dermatomyositis, but paraneoplastic dermatomyositis often requires additional immune-modulating therapies. 100 In most cases, successful tumor-directed therapy will also ameliorate symptoms;…”

“…Development of these disorders often precedes a diagnosis of cancer or recurrence of a previously treated malignancy. 100,101 The clinical features, associated malignancies, diagnostic studies, and treatment of paraneoplastic dermatologic and rheumatologic syndromes are listed in Table 3. 100-132 A more detailed discussion of selected syndromes follows.…”