| Table 3-26 Paraneoplastic Cutaneous Manifestations |
| | Entity | | Clinical Findings | | Underlying Cancer |
| | Acanthosis nigricans (AN)
(Figure 3.48A) | | Velvety hyperpigmentation (body folds) | | Most common: GI adenocarcinoma (gastric) |
| | Acquired angioedema
(Figure 3.50C) | | Angioedema without urticaria | | Lymphoproliferative diseases |
| | Acquired ichthyosis | | Diamond-shape scale (often legs) | | Lymphoma (Hodgkin and NHL) |
| | Alopecia neoplastica | | Cicatricial localized loss of hair | | Breast cancer (metastatic) |
| | Primary amyloidosis
(Figure 3.49A) | | Periorbital ‘pinch’ purpura | | Multiple myeloma (one fourth of cases) |
| | Bazex sign
(Acrokeratosis neoplastica)
(Figure 3.50A) | | Psoriasiform plaques on palms, soles, nose and ear helices | | Upper aerodigestive tract carcinoma |
| | Carcinoid syndrome | | Head/neck flushing, pellagra-like dermatitis, erythema
{↑ 5-HIAA levels (hydroxyindoleacetic acid), a serotonin metabolite} | | Mid-gut tumors (w/ liver metastases), gastric/bronchial carcinoid tumors |
| | Cryoglobulinemia | | Purpura, acrocyanosis, livedo reticularis | | Lymphoplasmocytic disorders |
| | Dermatomyositis | | Gottron’s papules, poikiloderma | | GI and ovarian cancer |
| | Erythema gyratum repens
(Figure 3.50D) | | Gyrate polycyclic plaques with trailing scale | | Various malignancies, bronchogenic carcinoma most common |
| | Hypertrichosis lanuginosa acquisita | | Sudden growth of soft, downy hair in adult | | Lung and colon cancer |
| | Metastases, cutaneous
(Figure 3.49F) | | Pink/violaceous papules/nodules | | Most common: breast and lung |
| | Multicentric reticulohistiocytosis
(Figure 3.49D) | | Erythematous papules mainly over face and dorsal hands; arthritis | | Various malignancies (30% with underlying cancer) |
| | Necrolytic migratory erythema (NME) | | Erythematous patches with bullae over face, groin and abdomen (severe intertrigo) | | Pancreatic carcinoma (α-cell tumor)
{Glucagonoma syndrome: glucagon-secreting carcinoma, NME, weight loss, glossitis, DM} |
| | Necrobiotic xanthogranuloma | | Yellow plaque commonly seen periorbitally | | Paraproteinemia, occasionally myeloma |
| | Nodular fat necrosis | | Subcutaneous nodules (legs) | | Pancreatic carcinoma |
| | Paget’s disease
(Figure 3.49B) | | Eczematous to psoriasiform plaque | | Adnexal, breast, GU or GI cancer |
| | Paraneoplastic pemphigus | | Erosive disease of mucous membranes | | Lymphoma, CLL |
| | Pruritus | | Localized or generalized | | Hodgkin’s lymphoma mainly |
| | Pyoderma gangrenosum (Figure 3.49E) | | Rapidly expanding ulceration with undermined border | | Hematologic malignancy (especially atypical bullous form) |
| | Sign of Leser-Trélat | | Suddent onset of multiple seborrheic keratoses | | Various malignancies: carcinoma (gastric, colon, breast) and lymphoma |
| | Sweet’s syndrome | | Erythematous, pseudovesicular papules, nodules and plaques | | Acute myelogenous leukemia, less commonly lymphoma |
| | Tripe palms
(Acanthosis palmaris)
(Figure 3.49C) | | Thickened, velvety palms witih pronounced dermatoglyphics | | Lung cancer (if only palms), gastric cancer (if palms + AN) |
| | Xanthoma, plane | | Yellow, thin plaques favoring trunk, periorbital and body folds | | Monoclonal gammopathy including multiple myeloma |
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