Metastatic pulmonary melanoma complicated with erythroderma and recurrent sepsis

Abstract

Erythroderma is occasionally associated with lung cancer. Here we report a 69-year-old male who has history of melanoma from 8 years ago presented with erythroderma associated with skin, soft tissue and pulmonary infection. CT chest showed a single enlarging right upper lobe lung nodule. Biopsy showed evidence of adenocarcinoma, and eventually proven to be metastatic melanoma. The patient improved after antibiotics and antifungal treatment. To our knowledge, this is the first case of melanoma metastasis presented as erythroderma as paraneoplastic syndrome.

Paraneoplastic erythroderma: an insight on the existing data

“…Multiple case series or case reports on isolated cases bring light to the clinical characteristics of patients who present with paraneoplastic erythroderma (Table 2). 23–51 …”

“…The majority of the case reports concerning patients with paraneoplastic erythroderma concern mostly patients with a pulmonary malignancy, 23–28 hematologic malignancies other than mycosis fungoides or Sezary syndrome, 29–36 and malignancies of the gastrointestinal tract 37–45 . Isolated reports on erythroderma associated with other visceral malignancies less frequently seen, such as renal, breast, or prostate cancer, are also present in the literature 46–51 …”

“…A careful examination of the reported cases reveals that paraneoplastic erythroderma tends to affect mainly the elderly population, with its incidence peaking after the sixth decade of life 23–51 . Malignancy‐associated erythroderma is only rarely seen in younger adults 30,34,35 .…”

“…Malignancy‐associated erythroderma is only rarely seen in younger adults 30,34,35 . Another interesting observation is the fact that in almost all cases, the performed skin biopsy demonstrates mostly nonspecific findings, such as acanthosis, spongiosis, and perivascular infiltration of inflammatory cells, thus failing to be of real diagnostic value 26–35,38–40,42–51 . Cases where the skin biopsy was indicative of a potential occult malignancy were when a coexisting dermatosis, such as dermatomyositis, was diagnosed 36,37,41 .…”

“…30,34,35 Another interesting observation is the fact that in almost all cases, the performed skin biopsy demonstrates mostly nonspecific findings, such as acanthosis, spongiosis, and perivascular infiltration of inflammatory cells, thus failing to be of real diagnostic value. [26][27][28][29][30][31][32][33][34][35][38][39][40][42][43][44][45][46][47][48][49][50][51] Cases where the skin biopsy was indicative of a potential occult malignancy were when a coexisting dermatosis, such as dermatomyositis, was diagnosed. 36,37,41 Since dermatomyositis is considered to constitute a facultative paraneoplastic dermatosis itself, 37 the diagnostic examinations on those patients were oriented faster toward screening for a malignant process.…”