Video Blog: Skin as a Window: Identifying Cancer Syndromes Through Cutaneous Clues

In this video blog, Anisha Patel, MD, discusses a few highlights from her lecture Skin as a Window: Identifying Cancer Syndromes Through Cutaneous Clues at the 2nd Annual Elevate-Derm Alliance Summer Conference at the Grand Hyatt Deer Valley in Park City, Utah.

In this video

Speaking with Veronica Richardson, MSN, CRNP, Dr. Patel organizes the topic into three buckets — paraneoplastic syndromes, cancer syndromes, and cutaneous metastases. For paraneoplastic pemphigus, she notes these patients are usually hospitalized and "pretty sick," and because the nasal mucosa and lips are involved, the biggest thing on the differential is Stevens-Johnson syndrome. The distinction matters: with SJS you're hunting for a causative drug, while with paraneoplastic pemphigus you're looking for an associated tumor. She stresses that indirect immunofluorescence is key, whereas biopsy is less useful for confirming paraneoplastic pemphigus and more useful for ruling out SJS.

She also highlights Bazex syndrome, a paraneoplastic acral condition that can mimic palmoplantar psoriasis but appears as a fulminant eruption in someone with no personal or family history of psoriasis, with disproportionately distal involvement of the nails and fingertips. For a sebaceous neoplasm on the head and neck, she recommends checking whether the patient has had a colonoscopy and referring for genetic counseling to evaluate for Lynch syndrome (Muir-Torre). On cutaneous metastases, she explains the scalp is a common site because it is highly vascularized and may get less chemotherapy penetration, with melanoma and colorectal cancer being the most common.

• In hospitalized patients with lip and nasal mucosal involvement, distinguish paraneoplastic pemphigus from Stevens-Johnson syndrome — SJS points to a drug, paraneoplastic pemphigus points to an underlying tumor.
• Don't forget indirect immunofluorescence for paraneoplastic pemphigus; biopsy is more useful for ruling out SJS than confirming the diagnosis.
• Consider Bazex syndrome when "palmoplantar psoriasis" erupts in a patient with no prior or family history, with disproportionately distal involvement of the nails and fingertips.
• A sebaceous neoplasm on the head and neck without a prior colonoscopy warrants genetic counseling and colonoscopy to evaluate for Lynch syndrome (Muir-Torre) — identifying these families can save lives.
• The scalp is a common site for cutaneous metastases due to rich vascularization and possibly poorer chemotherapy penetration; melanoma and colorectal cancer are the most common primaries.