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

Dermatomyositis and Erythema Gyratum Repens

Dermatomyositis (DM) is an inflammatory condition resulting in proximal myopathy, violaceous (heliotrope) inflammatory changes of the periorbital areas and the eyelids, erythematous urticarial patches that spread from the face to the neck and later to the shoulders and arms, and flat-topped violaceous papules over the knuckles (Gottron's papules). Periungual telangiectasis, cuticular overgrowth, poikiloderma, and scaly alopecia are also found. Calcinosis cutis more commonly is present in juvenile dermatomyositis. Systemic symptoms may include symmetrical proximal muscle fatigue, fever, anorexia, weight loss, and Raynaud's syndrome.

Patients with DM who are older than age 50 years have an increased risk for developing cancer; 25%-30% have an associated malignancy.[17] Callen[18] studied 57 patients with DM and malignancy and found that the diagnosis of cancer occurred before diagnosis of DM in 39% of cases, after diagnosis of DM in 34% of cases, or concurrent with diagnosis of DM in 27% of cases. Ovarian cancer is more frequently observed in patients with DM than in the general population, but the other types of cancers seen in patients with DM are similar to those found in the general population, so patients should have a malignancy workup appropriate for their age. Most cancers occur within 2 years of diagnosis,[19] so patients should be screened for at least 3 years following the initial diagnosis of DM.

Erythema Gyratum Repens (EGR) is characterized by concentric erythematous, scaly bands with a wood grain appearance. The lesions are frequently pruritic and affect the trunk and proximal extremities, sparing the face, hands, and feet. Less commonly, palmoplantar keratoderma and ichthyosis may be present. In one report,[20] 84% of patients with EGR had an associated neoplasia, most commonly lung cancer. Other sites developing malignancy related to EGR are breast, urinary bladder, uterus, GI tract, and prostate. The eruption usually precedes the detection of the neoplasia, and it commonly improves or resolves after treatment of the malignancy.