List of cutaneous conditions associated with internal malignancy

List of Cutaneous Conditions Associated with Internal Malignancy

Cutaneous conditions associated with internal malignancy comprise a diverse group of skin manifestations that can be the first clue to the presence of an underlying cancer. These conditions can range from benign-looking rashes to overtly malignant skin lesions. Recognizing these conditions is crucial for early diagnosis and treatment of the associated malignancy. This article provides an overview of the most common cutaneous conditions linked with internal cancers, emphasizing their clinical features, associated malignancies, and the underlying mechanisms when known.

Overview

Cutaneous manifestations of internal malignancies can be classified into several categories based on their pathophysiology: paraneoplastic syndromes, genetic syndromes with predisposition to cancer, direct tumor invasion, and metabolic and nutritional disorders caused by the tumor. Paraneoplastic syndromes are particularly significant because they result from tumor-induced systemic effects, not directly from tumor invasion or metastasis.

Common Cutaneous Conditions Associated with Internal Malignancy

Acanthosis nigricans: This condition is characterized by dark, velvety plaques that typically appear in body folds and creases. It is most commonly associated with gastrointestinal malignancies, especially gastric adenocarcinoma.

Dermatomyositis: Dermatomyositis presents with a distinctive skin rash and muscle weakness. It is often associated with underlying malignancies, including ovarian, lung, pancreatic, and colorectal cancers.

Erythema gyratum repens: This rare paraneoplastic skin condition is characterized by concentric, wood-grain-like erythematous bands. It is most commonly associated with lung cancer.

Leser-Trélat sign: The sudden appearance of multiple seborrheic keratoses can indicate an underlying malignancy, most often adenocarcinomas of the gastrointestinal tract.

Necrolytic migratory erythema: This condition is characterized by erythematous, blistering, and eroding skin lesions. It is often associated with glucagonoma, a rare pancreatic tumor.

Sweet's syndrome (acute febrile neutrophilic dermatosis): Sweet's syndrome presents with painful, red, and swollen skin lesions and is frequently associated with hematologic malignancies, such as acute myeloid leukemia.

Trousseau syndrome (migratory thrombophlebitis): This condition involves recurrent, migratory thrombophlebitis and is often a harbinger of an underlying malignancy, particularly pancreatic cancer.

Genetic Syndromes with Predisposition to Cancer

Some genetic syndromes predispose individuals to both cutaneous conditions and internal malignancies. Examples include:

Cowden syndrome: Characterized by multiple hamartomas and an increased risk of breast, thyroid, and endometrial cancers.

Gardner syndrome: A form of familial adenomatous polyposis that includes skin manifestations like epidermoid cysts and is associated with a high risk of colorectal cancer.

Muir-Torre syndrome: A variant of Lynch syndrome that includes sebaceous tumors and keratoacanthomas, with an increased risk of colorectal, endometrial, and other cancers.

Direct Tumor Invasion

In some cases, skin manifestations result directly from tumor invasion or metastasis to the skin. These conditions include:

Carcinoma erysipeloides: Erysipeloid skin lesions caused by direct invasion of skin lymphatics by carcinoma cells, most often from breast cancer.

Carcinoma telangiectaticum: A form of cutaneous metastasis where lesions appear as erythematous patches with telangiectasia, often associated with breast cancer.

Metabolic and Nutritional Disorders

Certain cutaneous conditions reflect metabolic and nutritional disorders caused by the tumor, such as:

Acquired ichthyosis: This condition presents as widespread dry, scaly skin and can be associated with Hodgkin lymphoma and other lymphomas.

Pruritus: Generalized itching without an apparent cause can be an early sign of internal malignancies, including lymphoma and liver cancers.

Conclusion

The recognition of cutaneous conditions associated with internal malignancy is crucial for the early detection and treatment of cancer. Dermatologists and oncologists should work together to evaluate patients presenting with these skin manifestations for possible underlying malignancies.

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