Phys · dermatological
Skin Signs of Internal Malignancy
Also known as Skin Signs of Internal Malignancy · skin signs of internal malignancy
Consultant-physician depth guide to cutaneous paraneoplastic syndromes for FRACP DWE/DCE — malignant acanthosis nigricans and tripe palms with gastric cancer, necrolytic migratory erythema with glucagonoma, dermatomyositis malignancy screening, Trousseau thrombophlebitis, Curth's postulates and the targeted tumour workup. Structured for FRACP DWE/DCE, MRCP and ABIM preparation.
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Red flags
- Sudden-onset severe pruritic acanthosis nigricans with weight loss in an older adult is gastric adenocarcinoma until proven otherwise — book gastroscopy, not dietetics
- Adult dermatomyositis carries a 15 to 25 per cent malignancy risk, highest in the first year — run age-appropriate screening plus CT and anti-TIF1-gamma/anti-NXP2 at diagnosis
- Migratory blistering erythema with diabetes and weight loss is necrolytic migratory erythema — check a glucagon level and image the pancreas
- Migratory thrombophlebitis needs heparin rather than warfarin alone, plus a search for pancreatic or mucin-producing cancer
Meet the patient
A 68-year-old man arrives with velvety, hyperpigmented, itchy skin in his axillae and over his knuckles, a 6 kg weight loss in three months, and new onset of diabetes. His GP has prescribed a potent topical steroid for a month with no effect.[2][3]
The registrar calls it obesity-related acanthosis nigricans and books a dietitian. The examiner's question: "What makes this malignancy-related rather than benign, and what single investigation must you do today?" Sudden onset, severity, weight loss and pruritus — book the gastroscopy.[2][3]
References11ShowHide
- [1]Wick MR, Patterson JW Cutaneous paraneoplastic syndromes Seminars in diagnostic pathology, 2019.PMID 30736994
- [2]Matsuoka LY, Wortsman J, Goldman J Acanthosis nigricans Clinics in dermatology, 1993.PMID 8339195
- [3]Boyce M, Flower C Tripe Palms The New England journal of medicine, 2022.PMID 35866753
- [4]Waldman R, DeWane ME, Lu J Dermatomyositis: Diagnosis and treatment Journal of the American Academy of Dermatology, 2020.PMID 31279813
- [5]Bernard P, Bonnetblanc JM Dermatomyositis and malignancy The Journal of investigative dermatology, 1993.PMID 8423382
- [6]Hu T, Vinik O Dermatomyositis and malignancy Canadian family physician Medecin de famille canadien, 2019.PMID 31189628
- [7]Foss MG, Hashmi MF, Ferrer-Bruker SJ Necrolytic Migratory Erythema 2026.PMID 30422467
- [8]Bosch-Amate X, Riera-Monroig J, Iranzo Fernández P Glucagonoma-related necrolytic migratory erythema Medicina clinica, 2020.PMID 31515063
- [9]van Beek AP, de Haas ER, van Vloten WA et al. The glucagonoma syndrome and necrolytic migratory erythema: a clinical review European journal of endocrinology, 2004.PMID 15538929
- [10]Lee HJ, Jang YH Necrolytic migratory erythema CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2019.PMID 30858185
- [11]Huang N, Yin HY, Swan R Paraneoplastic Conjunctival Acanthosis Nigricans: A Case Report Cornea, 2021.PMID 32991358