When and How Should the Patient With Dermatomyositis or Amyopathic Dermatomyositis Be Assessed for Possible Cancer?

Callen, Jeffrey P.

doi:10.1001/archderm.138.7.969

Cited by 56 publications

(22 citation statements)

References 21 publications

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“…How the inflammatory myopathy patients should be assessed for possible cancers is still a matter of debate (23)(24)(25)(26). Surprisingly, the place of tumor markers assays for the search of occult malignancies in dermatomyositis and polymyositis has been poorly assessed (8,27).…”

Section: Discussionmentioning

confidence: 99%

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Amoura¹,

Duhaut²,

Huong³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Dermatomyositis and polymyositis patients have an increased risk of developing cancers. We have assessed the diagnostic values of serum tumor markers for the detection of solid cancer in dermatomyositis/polymyositis patients. Serum carcinoembryonic antigen, CA15-3, CA19-9, and CA125 were assayed by immunoradiometric methods in 102 dermatomyositis/polymyositis patients. All the patients had complete physical examination, chest X-ray, echocardiogram, gastrointestinal tract endoscopic explorations, thoracoabdominopelvic computed tomography scan, and all women had gynecologic examination and mammogram. Exclusion criteria for study were childhood dermatomyositis, inclusion body myositis, myositis associated with a connective tissue disease, prior history of cancer, and the presence of benign conditions known to elevate serum tumor markers. After a median follow-up of 59 months, 10 (9.8%) patients had a solid cancer. Initial elevation of CA125 was associated with an increased risk of developing solid cancer [P = 0.0001 by Fisher's exact test; odds ratio (OR), 29.7; 95% confidence interval (95% CI), 8.2-106.6]. For CA19-9, there was a trend towards a significant association (P = 00.7; OR, 4.5; 95% CI, 1-18.7, respectively). Diagnostic values of elevated CA125 and CA19-9 at screening increased when the study analysis was restricted to patients who developed a cancer within 1 year (P < 0.0001 and P = 0.018, respectively) or to patients without interstitial lung disease (P = 0.00001; OR, 133; 95% CI, 6.5-2733 and P = 0.027; OR, 9; 95% CI, 1.5-53, respectively). Individual comparisons of the baseline and the second CA125 value showed that three of the eight patients with cancers versus 3 of the 76 patients without, displayed an increase of their CA125 level (P = 0.01 by Fisher's exact test). We conclude that CA125 and CA19-9 assessment could be useful markers of the risk of developing tumors for patients with dermatomyositis and polymyositis and should therefore be included in the search for cancer in dermatomyositis/ polymyositis patients, especially for patients without interstitial lung disease.

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Section: Discussionmentioning

confidence: 99%

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Amoura¹,

Duhaut²,

Huong³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…14 Recommendations for screening affected patients for cancer have changed over the years, with increasing evidence of an association between dermatomyositis and malignancy and evolving improvements in diagnostic techniques. 16 Many authorities recommend that all adult patients with dermatomyositis be evaluated for cancer, including a complete physical examination, basic hematological tests, age-and sex-appropriate screening (eg, mammography, pap smear, and colonoscopy), and chest x-ray. 16 Some would add upper endoscopy; imaging of the chest, abdomen, and pelvis; gynecological examination; and serum CA-125 level to better evaluate for the most common malignancies (ie, ovarian, gastric, lung, and pancreatic carcinomas and non-Hodgkins lymphoma).…”

Section: Commentarymentioning

confidence: 99%

“…16 Many authorities recommend that all adult patients with dermatomyositis be evaluated for cancer, including a complete physical examination, basic hematological tests, age-and sex-appropriate screening (eg, mammography, pap smear, and colonoscopy), and chest x-ray. 16 Some would add upper endoscopy; imaging of the chest, abdomen, and pelvis; gynecological examination; and serum CA-125 level to better evaluate for the most common malignancies (ie, ovarian, gastric, lung, and pancreatic carcinomas and non-Hodgkins lymphoma). 12,[17][18][19][20] In 19% of adults, dermatomyositis overlaps with other autoimmune disorders, usually systemic lupus erythematosus and systemic sclerosis.…”

Section: Commentarymentioning

confidence: 99%

“Are we there yet?”

Williams

Raugi

Dhaliwal

et al. 2007

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through presentation of an actual patientA 62-year-old man with psoriasis for more than 30 years presented to the emergency department with a scaly, pruritic rash involving his face, trunk, and extremities that he had had for the past 10 days. The rash was spreading and not responding to application of clobetasol ointment, which had helped his psoriasis in the past. He also reported mild pharyngitis, headache, and myalgias.A patient with a chronic skin condition presenting with a new rash means the clinician must consider whether it is an alternative manifestation of the chronic disorder or a new illness. Psoriasis takes many forms including guttate psoriasis, which presents with small, droplike plaques and frequently follows respiratory infections (particularly those caused by Streptococcus). Well-controlled psoriasis rarely transforms after 3 decades, so I would consider other conditions. The tempo of illness makes certain life-threatening syndromes, including Stevens-Johnson, toxic shock, and purpura fulminans, unlikely. An allergic reaction, atopic dermatitis, or medication reaction is possible. Infections, either systemic (eg, syphilis) or dermatologic (eg, scabies), should be considered. Photosensitivity could involve the sun-exposed areas, such as the extremities and face. Seborrheic dermatitis can cause scaling lesions of the face and trunk but not the extremities. Vasculitis merits consideration, but dependent regions are typically affected more than the head. Mycosis fungoides or a paraneoplastic phenomenon could cause a diffuse rash in this age group.The patient had diabetes mellitus, hypertension, diverticulosis, and depression. Three months earlier he had undergone surgical drainage of a perirectal abscess. His usual medications were lovastatin, paroxetine, insulin, hydrochlorothiazide, and lisinopril. Three weeks previously he had completed a 10-day course of trimethoprim/sulfamethoxazole for an upper respiratory infection. Otherwise, he was taking no new medications. He was allergic to penicillin. He denied substance abuse, recent travel, or risk factors for human immunodeficiency virus (HIV) infection. He worked as an automobile painter, lived with his wife, and had a pet dog.Physical examination revealed a well-appearing man with normal vital signs. His skin had well-defined circumscribed pink plaques, mostly 1-2 cm in size, with thick, silvery scales in the ears and on the dorsal and ventral arms and legs, chest, back,

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“…2 Na forma juvenil, há maior incidência de calcinose cutânea. 10,11 O diagnóstico é realizado através da história e exame físico, sendo corroborado pelas enzimas musculares, biópsia muscular, biópsia cutânea, eletroneuromiografia (ENMG), ultra-sonografia (USG) e ressonância nuclear magnética (RNM). 2,10 O interesse pela dermatomiosite vem aumentando na última década não apenas pelo maior conhecimento imunológico sobre a doença, mas também devido ao progresso das técnicas de imagem, que tanto auxiliam no diagnóstico.…”

Section: Introductionunclassified

Dermatomiosite

Ortigosa

Reis

2008

An. Bras. Dermatol.

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Resumo: Dermatomiosite é doença idiopática inflamatória crônica que afeta a musculatura estriada, a pele e outros órgãos. Apresenta critérios diagnósticos definidos por Bohan & Peter, podendo os pacientes ser classificados em cinco grupos: dermatomiosite juvenil, dermatomiosite primária idiopá-tica, dermatomiosites amiopáticas, dermatomiosite associada a neoplasias e dermatomiosite associada a outras doenças do tecido conectivo. O sexo feminino é mais afetado, e a idade média do diagnósti-co é 40 anos. Manifestações cutâneas são observadas em todos os pacientes. Das alterações sistêmicas, a manifestação muscular mais freqüente é a perda de força proximal, e a manifestação pulmonar mais comum é a pneumopatia intersticial. Podem ser observadas neoplasias durante o seguimento da doença, sendo mais freqüentes nos pacientes acima de 60 anos. A desidrogenase lática é a enzima muscular alterada na maioria dos casos. Para diagnóstico da dermatomiosite, pode ser realizado exame anatomopatológico de biópsia cutânea e biópsia muscular, além de eletroneuromiografia. Os corticóides são a terapia mais utilizada. As causas de óbito mais freqüentes são a neoplasia maligna, a septicemia e a infecção pulmonar.

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When and How Should the Patient With Dermatomyositis or Amyopathic Dermatomyositis Be Assessed for Possible Cancer?

Cited by 56 publications

References 21 publications

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

“Are we there yet?”

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