Dermatological paraneoplastic syndromes

Pruritus

Common; characteristic of HD, leukaemias, CNS tumours, NHL.

Pigmentation

Acanthosis nigricans Itchy brown hyperkeratotic plaques, mainly in flexures; may precede cancers by many years; associated with GIT tumours e.g. gastric adenocarcinoma.

Vitiligo Patchy depigmentation, especially face, neck, and hands; associated with malignant melanoma; possibility due to anti-melanoma immune response.

Erythematous

Necrolytic migratory erythema Islet cell tumour. Exfoliative dermatitis—cutaneous T-cell lymphoma.

Bullous

Pemphigus Characteristic bullous lesions on skin and mucous membranes; associated with lymphoma, Kaposi's sarcoma, thymic tumours.

Dermatitis herpetiformis Chronic, intensely itchy vesicles over elbows, knees, and lower back; precede tumour by many years; associated with lymphomas e.g. NHL of the small intestine.

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