Derm Pics: Indications Of Internal Malignancy

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Malignant Acanthosis Nigricans - phenotypic marker for gastric cancer
(most are non-malignant)

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Malignant Acanthosis Nigricans - phenotypic marker for gastric cancer
(most are non-malignant)

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Tripe palms
Highly associated with malignancy - mostly stomach (some lung)

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also, areas of presentation

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Bazex syndrome = acrokeratosis paraneoplastica
Note: scaling and keratoderma of nail and skin (fungus wouldn't involve all surfaces) - presents on feet, hands, nose, ear helices
Course of rash parallels malignancy - typically SCC of upper aerodigestive tract

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also, when does it indicate malignancy

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Suborrheic keratosis - usually benign, in elderly
When Leser-Trelat sign (rapid increase in number) is present = stomach adenocarcinoma

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also, when does it indicate malignancy

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Suborrheic keratosis - usually benign, in elderly
When Leser-Trelat sign (rapid increase in number) is present = stomach adenocarcinoma

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also, what sign indicates a specific associated malignancy

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Necrolytic migratory erythema - usually indicates malignancy
Note: widespread, irregular erythematous plaques with erosions, vesicles, bullae
When seen with trousseau's sign (superficial thrombophlebitis) = glucagonoma (pancreatic alpha cell cancer)

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Sweet's syndrome (less advanced) = acute febrile neutrophilic dermatosis
Associated with acute myelogenous leukemia
Note: rapid onset of tender, erythematous plaques

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also, common area

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Sweet's syndrome (more advanced) = acute febrile neutrophilic dermatosis
Associated with acute myelogenous leukemia
Note: necrosis occurs in areas that had plaques (lesion on finger is ex of a precursor)
Most characteristic area of presentation on dorsal surface of wrists

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Sweet's syndrome (more advanced) = acute febrile neutrophilic dermatosis
Associated with acute myelogenous leukemia
Note: violaceous to red, demarcated, firm, angular, probably on trunk (usually on posterior aspect)

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also, common area

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Pyoderma gangrenosum
Note: full thickness ulceration with hyperemic (engorged with blood flow) border - most common on anterior aspect of leg
Associated with IBS and myeloproliferative disorders, especially AML/CML (acute/chronic myelogenous leukemia)

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also, describe progression of lesions

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Pyoderma gangrenosum
Note: start (top) as tender, violaceous papules/nodules that transition into bullae, erosions, and ulcerations with purulent base
Associated with IBS and myeloproliferative disorders, especially AML/CML (acute/chronic myelogenous leukemia)

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Erythema Gyratum Repens
Note: erythematous serpentine pattern of scaly plaques
*very itchy
Heralds onset of malignancy, usually lung

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Erythema Gyratum Repens
note: classic wood grain appearance with islands of normal skin- concentric erythematous bands with mild scale
*very itchy
Heralds onset of malignancy, usually lung

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dermatomyositis - Gottron's sign (plaques on hand joints)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - heliotrope rash (red eyelids - above and below)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - heliotrope rash (red eyelids - above and below)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - Gottron's sign (plaques on hand joints)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - nail fold telangiectasia and cuticular dystrophy (samitz sign)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - shawl sign poikiloderma-violaceous (photodistribution of extensor surfaces of face, neck, chest, shoulders)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - facial poikiloderma-violaceous (photodistribution of extensor surfaces of face, neck, chest, shoulders)
Not a malignant sign in children

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dermatomyositis - poikiloderma-violaceous (photodistribution of extensor surfaces of face, neck, chest, shoulders)
Not a malignant sign in children

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dermatomyositis - Gottron’s papules on IP joints (DM) with Gottron’s sign (erythematous, violaceous scaling) on skin in between joints
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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dermatomyositis - nail fold telangiectasia and cuticular dystrophy (samitz sign)
1-2 years before tumor, increased cancer (adults only)
women = ovarian>breast; men = stomach & lung

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Calcinosis cutis on a child with dermatomyositis - complication of the juvenile form (not related to a malignancy)

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Paraneoplastic pemphigus with mucosal involvement (mouth and tongue more involved than compared to steven's johnson syndrome)
Note: Painful ulcers, bullae of mouth, lips, esophagus and skin
Lymphoreticular malignancy (Non-H Lymphoma, leukemia, etc)

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Paraneoplastic pemphigus with mucosal involvement (mouth and tongue more involved than compared to steven's johnson syndrome)
Note: Painful ulcers, bullae of mouth, lips, esophagus and skin
Lymphoreticular malignancy (Non-H Lymphoma, leukemia, etc)

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Paraneoplastic pemphigus with mucosal involvement (mouth and tongue more involved than compared to steven's johnson syndrome)
Note: Painful ulcers, bullae of mouth, lips, esophagus and skin
Lymphoreticular malignancy (Non-H Lymphoma, leukemia, etc)

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Digital clubbing (angle 180) - present on ALL digits bilaterally
Associated with lung (most - cancer and COPD) and heart malignancy

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Erythroderma - diffuse erythema and desquamation; painful
Note: this is later stage so is more scaley
RARELY associated with hematopoetic and solid tumors

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Erythroderma - diffuse erythema and desquamation; painful
RARELY associated with hematopoetic and solid tumors

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Erythroderma - diffuse erythema and desquamation; painful
RARELY associated with hematopoetic and solid tumors

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Erythroderma - diffuse erythema and desquamation; painful
RARELY associated with hematopoetic and solid tumors

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also, other signs that associate it with malignancy

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Flushing associated with carcinoid syndrome (a vasoactive process - vasoactive amines spewed out by carcinoid tumor somewhere in body)
GI tumor most common
Signs: nausea, vommiting, diarrhea, abdominal pain, palpatations, wheezing, BP lability. Check for hepatomegaly on exam

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also, other signs that associate it with malignancy

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Flushing associated with carcinoid syndrome (a vasoactive process - vasoactive amines spewed out by carcinoid tumor somewhere in body)
GI tumor most common
Signs: nausea, vommiting, diarrhea, abdominal pain, palpatations, wheezing, BP lability. Check for hepatomegaly on exam

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also, associated sign

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Hypertrichosis lanuginosa acquisita = malignant down
Note: Excessive light-colored fine hair growth w/o other signs of virilization (masculinization)
Tongue will be inflamed with bumpy texture
Fairly high sensitivity for underlying cancer (lung, breast, uterine, colorectal, lymphoma, bladder)

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Planar xanthoma of the neck (most common area is face and neck)
Note: yellowish (cholesterol-rich) materials accumulate in plaques
Associated with multiple myeloma

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Planar xanthoma of the palms (other sites are axilla and chest)
Note: yellowish (cholesterol-rich) materials accumulate in plaques
Associated with multiple myeloma

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Planar xanthoma of the neck (most common area is face and neck)
Note: yellowish (cholesterol-rich) materials accumulate in plaques
Associated with multiple myeloma

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ACTH secreting tumor increases melanin production
Associated with small cell lung cancer (and Cushing's syndrome)

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ACTH secreting tumor increases melanin production
Associated with small cell lung cancer (and Cushing's syndrome)