Palmar Erythema: Cutaneous Marker of Neoplasms

Abstract

Background: Acral erythema on the palms is observed in several conditions. However, the relationship with malignant tumors has only been reported exceptionally. It should be noted that tumors produce angiogenic mediators. Objective: These mediators might promote palmar erythema (PE), and the aim of the present study was to investigate the vasodilation of palmar skin capillaries and angiogenesis, mainly with tumors of the central nervous system. Methods: In a prospective study of 107 patients affected by brain tumors, we assessed PE clinically and the rate of dilated vessels histologically. We also evaluated the mean surface of the lumen of capillaries on skin biopsies and brain tumors. Results: 6.5% of the patients had an important erythema and 18.5% had slight and/or localized PE. In the skin biopsies, the rate of dilated vessels and the mean surface of the lumen of capillaries were higher than in normal skin. Moreover, the intensity of palmar redness was related to the increase in these vascular changes in the histopathological slices of brain tumors. The intensity also depended on the type of tumor and on its growth. Conclusion: The results of the present study strongly suggest that acral erythema is associated with malignant tumors and that the intensity of erythema and the vascular changes of brain tumors are related, probably due to angiogenic factors.

Skin findings in internal malignant diseases

“…Noble et al . found palmar erythema in 27 of 107 brain tumors (25.1%) 23 . In our study, we found palmar erythema at a rate of 0.28% (2 of 700 cases).…”

“…found palmar erythema in 27 of 107 brain tumors (25.1%). 23 In our study, we found palmar erythema at a rate of 0.28% (2 of 700 cases). Contrary to these reports we found palmar erythema in two patients with breast cancer.…”

The hand‐foot‐syndrome associated with medical tumor therapy – classification and management

“…Because it occurred in patients after beginning cytotoxic chemotherapy, with rapid improvement upon discontinuing therapy, it was believed to be a side effect associated with various cytostatic agents [2]. Nevertheless, there were isolated reports of clinical appearances similar to chemotherapy‐associated HFS in patients with neoplasia [3, 4] or graft‐versus‐host disease [5]. HFS is characterized by painful erythematous lesions which mainly affect palmoplantar surfaces.…”

Palmar erythema as a sign of cancer

“…2,5 In a clinicopathologic study of brain tumors, palmar erythema was recognized in 27 (25%) of 107 patients. 5 Histologic examination in that study demonstrated that the intensity of erythema correlated with both cutaneous vessel dilation and prominent vascularization in the patients' brain tumors, suggesting the role of circulating angiogenic factors such as VEGF. VEGF is a potent mediator of angiogenesis, which is critical for tumor development and growth.…”