CUTANEOUS REACTIONS TO INTERNAL MALIGNANCY

Skin problems in advanced and terminal cancer patients

Disturbances caused by skin problems may compromise the quality of life of cancer patients. The main complications affecting the skin comprise the dermatologic toxicity of anticancer therapy, bedsores, malignant ulcers, sores due to nonmetastatic cancer, pruritus, and infections. Most of the information available about these entities has been acquired in the cancer patient without advanced disease. The little currently known about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented, and approaches to management are suggested.

Herpes simplex mimicking leukemia cutis

We present a patient with chronic lymphocytic leukemia who developed a painful penile ulcer that was initially diagnosed as leukemia cutis, as evidenced by an atypical leukemic infiltrate on biopsy. A Tzanck preparation was positive for multinucleated giant cells, and the diagnosis of herpes genitalis was confirmed by viral culture. In patients with hematologic malignancies, herpes simplex virus must be included in the differential diagnosis of ulcerative lesions. The histopathologic findings of inflammatory dermatoses in these patients may include an atypical infiltrate, because of the predominance of atypical inflammatory cells in the peripheral circulation.

Bullous pemphigoid and psoriasis: does subclinical bullous pemphigoid exist?

Four cases are presented in which probable bullous pemphigoid and probable psoriasis co-existed. One case represents a simple coincidence of the two diseases. In the other three cases, the bullous lesions were transient and seemed to be induced by elements of the Goeckerman regimen. The hypothesis is presented that these three cases represent a subclinical form of bullous pemphigoid induced by the irritant effects of coal tar, ultraviolet light, the reduced barrier function of a pre-existing dermatosis, or a combination of these factors.

Febrile neutrophilic dermatosis in acute myelogenous leukemia

Three patients with acute myelogenous leukemia and adequate granulocyte reserves developed fever and painful indurated erythematous plaques on their extremities and faces. The plaques became studded with vesicles or bullae and occasionally became necrotic. Histologic examination revealed dermal edema, infiltration with granulocytes, and formation of intraepidermal vesicles. Efforts to relate the skin reaction to infiltration of leukemic cells, microorganisms, or allergic phenomena were unsuccessful. Empiric antibiotic therapy was without effect. The symptoms and signs responded dramatically to systemic administration of corticosteroids. These lesions, which may cause diagnostic confusion and needless therapy with potent antibiotics, may represent another previously uncharacterized nonspecific skin reaction in patients with acute myelogenous leukemia.

Cutaneous manifestations of visceral malignancy

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