The cutaneous manifestations of gastrointestinal malignancy
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.
References (35)
- et al.
Tripe palms and cancer
Clin Dermatol
(1993) - et al.
Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients
J Am Acad Dermatol
(1990) - et al.
Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients
J Am Acad Dermatol
(1993) - et al.
Polymyositis, dermatomyositis and malignancy: a further intriguing link
Autoimmun Rev
(2010) - et al.
RHBDF2 mutations are associated with tylosis, a familial esophageal cancer syndrome
Am J Hum Genet
(2012) - et al.
Muir-Torre syndrome
Lancet Oncol
(2005) - et al.
Cancer-associated genodermatoses: skin neoplasms as clues to hereditary tumor syndromes
Crit Rev Oncol Hematol
(2013) - et al.
Acanthosis nigricans as a paraneoplastic syndrome. Case reports and review of literature
Pol Arch Med Wewnetrz
(2009) - et al.
Transforming growth factor-alpha (TGF alpha)-producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus
J Gastroenterol
(1997) - et al.
Cutaneous manifestations of gastrointestinal disease: part I
J Am Acad Dermatol
(2013)