Elsevier

Seminars in Oncology

Volume 43, Issue 3, June 2016, Pages 341-346
Seminars in Oncology

The cutaneous manifestations of gastrointestinal malignancy

https://doi.org/10.1053/j.seminoncol.2016.02.028Get rights and content

Abstract

The skin is often the herald of an underlying systemic illness, and gastrointestinal malignancies can present in numerous ways in the skin. Paraneoplastic phenomenon, such as acanthosis nigricans and tripe palm, may be the first indicator of a gastrointestinal malignancy. In addition, gastrointestinal cancers can metastasize to the skin, as described in the well-known Sister Mary Joseph’s nodule. Inflammatory systemic conditions such as dermatomyositis and multicentric reticulohistiocytosis can be associated with underlying malignancy. Finally, in numerous genetic syndromes with underlying malignancies, such as Muir-Torre, recognition of the skin signs leads to early diagnosis and screening.

Introduction

Numerous skin manifestations herald the presence of an underlying malignancy. These skin signs may be paraneoplastic eruptions, such as acanthosis nigricans and tripe palms, cutaneous metastases, inflammatory conditions, such as dermatomyositis, or benign or malignant growths seen in genetic syndromes. The astute physician with awareness of these skin findings, particularly with genodermatoses, will diagnose patients earlier with potential life-saving outcomes.

Section snippets

Acanthosis nigricans

Acanthosis nigricans is a symmetric, velvety, hyperpigmented skin thickening, most frequently in the axilla , sides of the neck, and groin, but can occur on any body surface. It can be congenital, acquired secondary to insulin resistance or other endocrinopathies, or rarely as a paraneoplastic phenomenon. When it develops in patients with an underlying malignancy, it tends to be more widespread, severe, occurs on mucosal surfaces, and in older, non-obese patients. It can also develop with the

Dermatomyositis

Dermatomyositis is an multisystem inflammatory disease that is characterized by a photosensitive poikilodermatous eruption on the upper back and chest (“shawl sign”), lateral hips (‘holster sign”), erythema and scaling on the scalp, erythematous papules and plaques overlying the metocarpophalangeal joints on the hands (“Gottron’s sign”), and cuticular and capillary nailfold changes. Proximal muscle weakness, interstitial lung disease, and esophageal dysmotility can also occur. Patients with

Howel-Evans syndrome

Tylosis with esophageal cancer, also known as Howel-Evans syndrome, is a genetic syndrome with palmoplantar keratoderma, or thickening of the skin on the palm and soles, and squamous cell carcinoma of the esophagus. It was first described in two families in England by Howel-Evans in 1958 [22]. Notably, 95% of those patients developed esophageal cancer by age 65 [22], [23]. The keratoderma is focal, most prominently on the pressure points, and can be very painful on the feet (Fig. 3). Oral

Summary

Paraneoplastic phenomenon that may indicate an underlying gastrointestinal malignancy include acanthosis nigricans, tripe palm, hypertrichosis lanuginosa, and Bazex syndrome. Cutaneous metastases of GI malignancy are a late finding and portend a poor prognosis. Conversely, recognition of the skin findings of genetic syndrome can lead to early diagnosis and appropriate screening.

Conflicts of interest

None.

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