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Paraneoplastic dermatological manifestation of gastrointestinal malignancies

Paraneoplastic dermatological manifestation – rare disorders resulting from the immune system’s response to a cancerous process (neoplasia) in the body. Gastrointestinal neoplasms more often cause paraneoplastic syndromes affecting the skin.

Possible skin lesions:

Acanthosis nigricans
Florid papillomatosis
Necrolytic Migratory Erythema
Palmoplantar keratoderma
Pancreatic panniculitis
Paraneoplastic acrokeratosis
Pityriasis rotunda

Clinical Symptoms

Paraneoplastic acrokeratosis (otherwise known as Bazex syndrome) – lesions similar to psoriasis or eczema are characteristic scaly patches of purple hue. Nail damage is also possible.

Localization:

Hands, feet, knees, ears, nose and cheeks
May be around the nails or damage to the nails themselves

Paraneoplastic acrokeratosis (otherwise known as Bazex syndrome)

Acanthosis nigricans:characteristic pigmented, velvety textured plaques (larger areas of palpable skin bumps)

Localization:

Typically on bending surfaces
Other places: back of the neck, armpits, groin

Necrolytic Migratory Erythema: characterized by migrating annular erythema (ring-shaped red spot), may be accompanied by lesions of the superficial skin layer and scabs.

Localization:

Body folds – in the torso, groin, buttocks, thighs
May be around the mouth area

Florid papillomatosis

sudden onset is characterized by abundant papillomas (warts) resembling viral warts. Growths are small in size (1-3 mm in diameter), with time they spread to other areas of the body. Itching occurs in 50% of cases.

Localization:hands, feet, knees, ears, nose and cheeks.

Pityriasis rotunda:characteristic oval-shaped, pigmented areas with scales.

Pink or light brown in color
Hyperpigmented (darker than skin color) – if the skin is dark. Hypopigmented (lighter than skin color) – if the skin is light.

Localization: torso and limbs

Palmoplantar keratoderma: manifests as unevenly distributed, focal or punctate hyperkeratosis (keratosis due to abnormal accumulation of keratin).
Localization: palms and soles

Pancreatic panniculitis: characterized by purple or reddened nodules and plaques (larger, palpable bumps on the skin) in the deeper layer of the skin. It may spontaneously ulcerate.

Localization: legs, torso, buttocks

Diagnostics

Certain criteria are used to assess whether the skin disease is a paraneoplastic syndrome:

Neoplasia and paraneoplasia begin at the same or similar time
Parallel course of conditions (as the tumor mass decreases, skin damage also decreases or vice versa)
Signs of a skin condition are not part of a genetic syndrome
A certain malignancy is associated with a certain paraneoplastic skin disease
A rare prevalence of skin disease in the general population
A frequent association between neoplasia and paraneoplasia

Treatment

The dermatologist carefully devises a tailored treatment strategy for each patient, considering the unique aspects of the paraneoplastic syndrome and the associated cancer.

The primary approach involves addressing the underlying cause of the syndrome.

This could encompass a variety of general treatment methods. Additionally, managing the particular symptoms of the syndrome plays a crucial role in enhancing the patient’s overall well-being.