Wednesday, April 21, 2010

The Answer is Cancer II


In the third image, those black spots all appeared within the time span of weeks. The base of some of those lesions is erythematous. They are itchy.

Challenge: What's the most likely cancer causing these skin manifestations?

Related Questions:
1. What does the first image show? What's the differential diagnosis of this finding?
2. What does the second image show?
3. What is the third image called? What are those spots?

First image shown under Creative Commons Attribution Share-Alike License 3.0. Second and third images shown under Fair Use.

4 comments:

Lucas said...

The first picture is acanthosis nigricans, a paraneoplastic syndrome found in many malignancies and in metabolic syndrome.
Unsure about the second picture.
The third picture is the Leser Trelat sign, when hundreds of seborrheic keratoses arise in a short period of time. Suggestive of GI malignancy (stomach and pancreas).

All told looks like a GI malignancy, possible gastric adenocarcinoma.

Lucas said...

I did a little looking and think the second picture may be tripe palms. Not necessarily a paraneoplastic syndrome but may suggest internal malignancy.

Suheil said...

First one's acnathosis nigricans- could be a sign of insulin resistance.. but coupled with other signs it could suggest internal malignancy..
Third one's migratory necrolytic erythema?? a sign of glucagonoma?
Not really sure of the second image..

Craig Chen said...

wow! nicely done lucas - i hadn't even heard of tripe palm until i started looking into this. glucagonoma is definitely a consideration, and migratory necrolytic erythema is pathognomonic for a glucagon-secreting tumor.
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The Answer is Cancer II

Although many malignancies are possible, gastroinestinal adenocarcinoma is most likely here. The first image shows acanthosis nigricans, an ill-defined velvety hyperpigmented plaque in intertriginous areas often seen with obesity and insulin resistance, but occasionally seen with gastrointestinal malignancies and lung cancer. The second image shows "tripe palm," a velvety thickening of the palms with an exaggeration of normal skin markings, associated with stomach and bronchogenic cancers. The third image shows the sign of Leser-Trelat, the explosive onset of multiple pruritic seborrheic keratoses, often with an inflammatory base. This is most associated with gastroinestinal adenocarcinomas, breast and lung cancers, and lymphoid malignancies.

Sources: UpToDate; first image from Wikipedia; second image reproduced from Fitzpatrick et. al, Color Atlas of Dermatology from UpToDate; third image from NEJM Images in Clinical Medicine.