Cutaneous Signs and Syndromes Associated With Internal Malignancies

Claudia C. Ramirez, MD; Brian Berman, MD, PhD


Skinmed. 2005;4(2):84-92. 

In This Article

Sweet's Syndrome (Acute Febrile Neutrophilic Dermatosis)

Sweet's syndrome is characterized by fever, neutrophilia, and an abrupt onset of erythematous, painful papules and nodules that coalesce to form irregular, sharply bordered plaques, primarily on the face, neck, and extremities. Pseudo-vesiculation, a vesiculated appearance due to intense edema, is commonly present. Extra-cutaneous manifestations of Sweet's syndrome are arthritis, conjunctivitis, and episcleritis. Histologically, it is characterized by an infiltrate predominantly of neutrophils that are diffusely distributed in the upper dermis.

Sweet's syndrome may be idiopathic (usually associated to upper respiratory infection), drug-induced, or associated with malignancy (paraneoplastic), in which the onset or recurrence of the skin lesions are temporally associated with the presence of cancer. Researchers[38] reviewed several retrospective studies to assess the incidence of malignancy associated with Sweet's syndrome. Of 448 persons studied, 96 (21%) presented with a hematologic malignancy or a solid tumor. The most common hematologic malignancy was acute myelogenous leukemia, and of the solid tumors, carcinomas of genitourinary organs, breast, and GI tract were frequent.[38] Findings that may suggest underlying malignancy include absence of antecedent respiratory infections, anemia, platelet abnormalities, and bullous pyoderma gangrenosum with more pronounced ulceration.[39]

Tripe palms is a condition characterized by pronounced dermatoglyphics and a thickened velvety appearance of the palms, and sometimes the soles, resembling in miniature the surface pattern of the villi in the small bowel. Histologically, hyperkeratosis, papillomatosis, and acanthosis are commonly seen.[40]

In a review of 77 patients with tripe palms,[40] more than 90% of published cases of tripe palms occurred in patients with cancer, and in 77% of cases, this condition was associated with acanthosis nigricans. The most common neoplasms were pulmonary and gastric carcinoma. In more than 40% of reported patients, tripe palms was the presenting sign of an underlying neoplasm; in 30% tripe palms followed the diagnosis of cancer.