What cancer syndromes affect the skin?
Erythema Gyratum Repens
What are the skin features of carcinoid syndrome?
Episodic flushing, mins - hours (no sweating)
GI carcinoid = liver mets
Bronchial, ovarian = can occur with no liver mets
What are the skin signs of paraneoplastic pemphigus?
Non-hodgkins, Castlemans disease (produces the autoantibody)
What is erythema graytum repens?
Concentric erythematous lesions
Variable sites & types of malignancy
What is acquired hypertrichosis lanuginosa?
Acute onset of lanugo hairs at face and body
•Colorectal ca > lung > breast, usually advanced
What is leser-trelat?
Eruptive seborrhoeic keratoses
What is Bazex syndrome?
•Hyperkeratosis of extremities
•Resembles psoriasis, non-specific fx on skin biopsy
What cancers are associated with Bazex syndrome?
•SCC: bronchial, oropharyngeal, GI
•Gastric, colon, biliary adenocarcinomas
What condition leads to generalised hyperpigmentation?
Tumour production of ACTH (ectopic ACTH syndrome)
Pigmentation also occurs in the mouth
•ACTH -> Inc. MSH -> release of melanin from melanocytes
What is pagets disease?
–Eczematous plaque at nipple / areola
–Extension of underlying ductal adenocarcinoma
The previous conditions until now have an underlying cancer in almost all cases
What is acanthosis nigricans?
Velvety hyperpigmentation of the skin of the skin
What is acanthosis nigricans associated with?
Strongly assocaited with gastric adenocarcinoma
Older patient, rapid onset
Other skin signs
What is dermatomyositis?
It is one of three inflammatory myopathies (can include muscle weakness)
•Inflammatory myopathy + rash
–Periorbital heliotrope rash
–Gottrons papules: red maculo-papular lesions over bony prominences
What conditions may be asociated with malignancy?
Pyoderma gangrenosum - this can be related to IBD or malignancy
Primary systemic amyloid
Cryoglobulinaemia - increase in the thickness of blood - blockage of small blood vesses
What are the genetic tumour syndromes with skin features?
Peutz-Jeghers: melanosis, colon hamartomas, colon ca
Muir-Torre: sebaceous tumours, keratoacanthomas, GI, breast, GU
Neurofibromatosis: Café au lait, Ax freckles, Neurofibromas, nerve sheath, phaeoCCyT, carcinoid
MEN syndromes: angiofibromas, neuromas, lichen or macular amyloid (MEN2), endocrine, P’s
Xeroderma pigmentosum: inability to repair sun damage, sarcoma, leukaemia, GI, lung
Howel-Evans: palmoplantar keratoderma, oesophageal
What are skin signs of genetic GI disease?
Hereditary haemorrhagic telangiectasia - abnormal blood vessel formation that leads to epistaxis and GI haemorrhage
Ehlers danlos (collagen) (connective tissue disroder, also presents with hypermobile joints)
Pseudo xanthoma elasticum (fragmentation and mineralisation of elastic fibres)
Blue rubber bleb naevus (vascular blue lesions
What are the inflammatory / autoimmune diseases of the GI tract associated with skin signs?
•Malignant atrophic papulosis (degos disease) (occlusive small vessel vasculopathy)
–> GI haemorrhage
What are the skin signs of diabetes?
•Acral erythema (reddening, swelling, numbness and desquamation of the palms of the hands and the souls of the feet)
•Carotenemia (yellow colouration of the skin and increased levels of beta-carotenes in the blood)
•Diabetic bullae (non-inflammatory blisters in the acral areas of the body - peripheral body parts: hand, feet ears, nose)
•Diabetic dermopathy - light brown scaly pathces often found on the shins of the front of the thighs
•Disseminated granuloma annulare - raised red skin lesions that form ring patterns
•Eruptive xanthomas - A condition affecting individuals with severe hyperlipemia in which groups of waxy yellow or yellowish-brown lesions appear suddenly, especially over extensors of the elbows and knees and on the back and buttocks
•Necrobiosis lipoidica - yellowish brown patch on the lower leg, the centre of the patch becomes pale and shiny, telangiectasia is also seen - the necrobiosis lipoidica is susceptibe to bleeding, ulcer formation and secondary infection
•Rubeosis - new abnormal blood vessels are found on the surface of the iris
•Scleredema - progressive thickening and hardening of the skin, usually on the areas of the upper back, neck, shoulders and face
What are the skin signs of thyroid disorders?
Hyperthyroid: Telogen effluvium (thinning or shedding of hair), moist skin, and hyperhidrosis (excessive sweating)
Hypothyroidism: dry skin (keratoderma), dry nails, and hair loss with madarosis (loss of eyelashes) are hallmark cutaneous features of the disease
What are the autoimmune conditions that present with skin changes?
Cutaneous lupus (acute: butterfly shaped malar rash, subacute: red-raised scaly non-scarring rash on sun exposed areas, discoid lupus is the most common chronic form of cutansous lupus) - not necessarily a systemic disease
Cutaneous vasculitis - inflamed blood vessels in the skin - IgA deposition on direct immunoflourescence, post infective, drug induced, idiopathic
Alopecia - T - lymphocyte, cytokine rejection of hair. (totalis involves loss of skull and facial hair, universalis is the loss of all hair) can be scarring
Vitiligo - segmental/generalised - destruction of melanocytes - associated with other immune conditions