Eruptive dermatosis papulosa nigra as a possible sign of internal malignancy

Abstract

A 42-year-old black woman presented with dermatosis papulosa nigra lesions of 15 years' duration. Coincident with the diagnosis of symptomatic iron-deficiency anemia about 1 year ago, she reported an "explosion" in number and size of the lesions progressing from her face to her trunk and arms. Physical examination revealed numerous 1-5-mm, black, smooth, verrucous papules predominantly on the forehead, malar region of the face, neck, and upper trunk (Figs 1 and 2). The lesions on the back were situated in a "Christmas tree" pattern and included two 1-cm papules. She had multiple 1-mm papules on the upper arms. A biopsy confirmed the diagnosis of dermatosis papulosa nigra, showing parakeratosis, acanthosis, hyperpigmentation, thick interwoven tracts of epithelial cells, and horn cysts. Given the eruptive nature of her disease, the possibility of an underlying malignancy was entertained. Six weeks later, she went to the emergency room for severe weakness; a colonoscopy revealed an ascending colon adenocarcinoma with a negative metastatic work-up.

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

“…4 DPN consists of round or filiform, hyperpigmented, smooth-surfaced, 1 to 5 mm papules. 20 These lesions usually appear on the forehead, cheek, neck, and upper trunk. 4 As with SK, an abrupt increase in the number of DPN papules may be associated with internal malignancy.…”

“…4 As with SK, an abrupt increase in the number of DPN papules may be associated with internal malignancy. 20 A strong pattern of inheritance is likely associated with DPN. 4,21 DPN most commonly appears in the periadolescent years, peaking in the sixth decade of life, and is more common in women.…”

Postprocedural wound-healing efficacy following removal of dermatosis papulosa nigra lesions in an African American population: A comparison of a skin protectant ointment and a topical antibiotic

“…2 They are classified as benign epidermal tumors and are not thought to be associated with systemic diseases or syndromes, 2 although there has been one case report of an abrupt increase in DPN papules possibly associated with internal malignancy. 10 While some patients have reported symptoms of pruritus, burning, irritation, and tenderness, removal of DPN lesions is primarily for cosmetic reasons. 1 Current treatment options include excision, electrodessication, cryosurgery with liquid nitrogen, curettage, dermabrasion, and laser removal.…”