Cutaneous manifestations of cancer and chemotherapy

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Cutaneous manifestations of cancer and chemotherapy Powered By Docstoc
					                                                                                                   Clinical Medicine 2009, Vol 9, No 4: 375–9



     pemphigus vulgaris: PEMPULS trial. Arch
     Dermatol 2006;142:570–6.
                                                       Cutaneous manifestations of cancer
21   Beissert S, Werfel T, Frieling U et al. A
     comparison of oral methylprednisolone
     plus azathioprine or mycophenolate
                                                       and chemotherapy
     mofetil for the treatment of pemphigus.
     Arch Dermatol 2006;142:1447–54.
22   Ahmed AR, Spigelman Z, Cavacini LA,               Emma Topham, Consultant Dermatologist,         ovary (4%).2 Lesions appear as firm, red
     Posner MR. Treatment of pemphigus vul-            Brighton and Sussex University Hospitals       or blue nodules, often multiple and close
     garis with rituximab and intravenous              NHS Trust, Brighton General Hospital           to the site of the primary tumour. The
     immune globulin. N Engl J Med
     2006;355:1772–9.
                                                                                                      scalp is a well documented site of metas-
23   Joly P, Mouquet H, Roujeau JC et al. A                                                           tasis for breast, lung and renal cancer.
     single cycle of rituximab for the treatment       It is important for general physicians to      Sister Mary Joseph’s nodule refers to a
     of severe pemphigus. N Engl J Med                 be aware of cutaneous signs and symp-          periumbilical nodule that can be associ-
     2007;357:545–52.                                  toms that may indicate the presence of         ated with stomach cancer.
24   Barnadas M, Roe E, Brunet S et al.
                                                       an underlying malignancy. Broadly there           Direct infiltration of the skin is seen with
     Therapy of paraneoplastic pemphigus
     with rituximab: a case report and                 are four categories to consider:               carcinoma erysipeloides, which can be mis-
     review of literature. J Eur Acad                                                                 diagnosed as cellulitis, and carcinoma en
     Dermatol Venereol 2006;20:69–74.                  •    cutaneous metastasis/direct tumour
                                                                                                      cuirasse, a hard infiltrated plaque. Both are
25   Schmidt E, Seitz CS, Benoit S, Bröcker EB,             spread
                                                                                                      most commonly associated with breast
     Groebeler M. Rituximab in autoimmune              •    inherited cancer syndromes with
                                                                                                      cancer. Paget’s disease is an intra-epidermal
     bullous diseases: mixed responses and                  cutaneous manifestations
                                                                                                      carcinoma seen in the nipple and areola
     adverse effects. Br J Dermatol
     2007;156:352–6.
                                                       •    cutaneous markers of exposure to
                                                                                                      area (mammary Paget’s) or anogenital and
                                                            carcinogens, and
                                                                                                      axillary skin (extramammary Paget’s).3
Address for correspondence:                            •    paraneoplastic syndromes.
                                                                                                      Paget’s disease of the breast presents as uni-
Dr R Groves, Clinical                                    Knowledge of the cutaneous manifes-          lateral, sharply demarcated nipple eczema
Immunodermatology, St John’s                           tations of systemic and targeted cancer        or erosion, often with bleeding or nipple
Institute of Dermatology, Guy’s                        therapy is also important.                     discharge, in association with underlying
Hospital, Great Maze Pond,                                                                            intraductal adenocarcinoma of the breast or
London SE1 9RT.                                        Cutaneous metastasis/direct                    non-invasive carcinoma. Extramammary
Email: richard.groves@kcl.ac.uk                        tumour spread                                  Paget’s disease is characterised by an itchy,
                                                                                                      moist, well-defined erythematous plaque,
                                                       In general, the skin is an uncommon site       typically in the anogenital area and most
                                                       of distant metastases (incidence 2–4%).1       common in elderly women. It is often mis-
                                                       The most common primary sites in men           diagnosed as psoriasis or Bowen’s disease
                                                       are lung (24%), colon (19%) and oral           (squamous carcinoma in situ). It is associ-
                                                       squamous cell carcinoma (12%) and in           ated with a local adnexal tumour in 25%
                                                       women breast (69%), colon (19%) and            of cases and with an internal malignancy,


                                                        Key Points
                                                        Direct infiltration of the skin with cancer can mimic cellulitis (carcinoma
                                                           erysipeloides) or scleroderma (carcinoma en cuirasse)

                                                        Extramammary Paget’s disease presents with persistent red plaques in the
                                                           anogenital or axillary area

                                                        Specific cutaneous lesions can be markers of internal cancer (inherited cancer
                                                          syndromes or genodermatoses); for example, sebaceous carcinoma/adenoma
                                                          can be a marker of bowel cancer in Muir-Torre syndrome

                                                        Dermatomyositis is associated with underlying malignancy in 15–41% of cases

                       
				
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