Cutaneous changes in patients with internal malignancies

Abstract

Objective: The aim of this study is to investigate skin findings in patients with internal malignancy and highlight the primary skin problems in these cases. Methods: In this study, the findings of cutaneous of 200 patients, hospitalized in the Department of Oncology Fırat University Hospital, were evaluated. The medical histories provided by the patients were recorded, comprehensive cutaneous and systemic examinations were performed, and clinical photos were taken. When considered necessary, skin biopsy and scrapings for fungal infections were collected, while all the cutaneous metastatic lesions were confirmed by histopathology. Results: Among the 200 inpatients with internal malignancy who were admitted to the Department of Oncology, 88 (44%) were female and 112 (56%) were male. Eighty-three patients (41.5%) had hair findings, while hair involvement was found to have a significant relationship with chemotherapy (p=0.001), number of cycles (p=0.001), and radiotherapy (p=0.04). As 119 patients (59.5%) exhibited nail findings, nail involvement was found to be linked with chemotherapy (p=0.001) and number of cycles (p=0.05). Oral mucosa involvement was observed in 100 patients (50%) and palmoplantar involvement was determined in 132 patients (66%); both were significantly associated with chemotherapy (p

Keywords

• Internal malignancy, skin lesions, cutaneous metastasis

İnternal maligniteli hastalarda deri değişiklikleri

Abstract

Giriş: İnternal maligniteler immünolojik, metabolik ve metastatik yollarla malign hücrelerin deriye metastazı, paraneoplastik sendromlar veya nonspesifik lezyonlar şeklinde çok sayıda deri bulgularına yol açabilirler. Amaç: Bu çalışmanın amacı internal maligniteli hastalarda deri bulgularını araştırmak ve bu hastalara yaklaşımda öncelikli deri sorunlarını irdelemektir. Yöntemler: Bu çalışmada karsinom tanısı almış, Fırat Üniversitesi Hastanesi Onkoloji servisinde yatarak tedavi gören iki yüz hastanın deri bulguları değerlendirildi. Hastaların anamnezleri kaydedildi, detaylı kutanöz ve sistemik muayene yapıldı, klinik fotografları çekildi. Gerekli görülen hastalarda deri biyopsisi, fungal enfeksiyonlar için kazıntı alındı ve tüm kutanöz metastatik lezyonlar histopatolojik olarak doğrulandı. Bulgular: Onkoloji servisinde yatmakta olan internal maligniteli 200 hastanın 88\'i (%44) kadın ve 112\'si (%56) erkekti. Hastalarda tanı konulan en sık primer tümörler 35 (%17,5) mide, 33 (%16,5) akciğer ve 31 (%15,5) kolorektal karsinomdu. Hastaların 83\'ünde (%41,5) saç bulguları mevcut olup saç tutulumunun kemoterapi (p=0,001), kür sayısı (p=0,001) ve radyoterapi (p=0,04) ile istatistiksel olarak anlamlı düzeyde ilişkili olduğu saptandı. Hastaların 119\'ünde (%59,5) tırnak bulguları mevcut olup, tırnak tutulumu kemoterapi (p=0,001) ve kür sayısı (p=0,05) ile ilişkili bulundu. Hastaların 100\'ünde (%50) oral mukoza tutulumu ve 132\'ünde (%66) palmoplantar tutulumu mevcut olup, her iki tutulum da alınan kemoterapi ile anlamlı düzeyde ilişkiliydi (p

Keywords

• İnternal malignite, deri lezyonları, kutanöz metastaz

References

1. Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol 1990;22:19-26.
2. Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol 1993;29:228-236.
3. Bravermen IM. Skin manifestations of internal malignancy. Clin Geriatr Med 2002;18:1-19.
4. Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy: diagnosis and management. Am J Clin Der- matol 2006;7:71-84.
5. Rajagopal R, Arora PN, Ramasastry CV, et al. Skin changes in inter- nal malignancy. Indian J Dermatol Venereol Leprol 2004;70:221- 225.
6. Ellis DL, Yats RA. Sign of leser-trelat. Clin Dermatol 1993;11:141- 148.
7. Kaplan RP. Specific cutaneous manifestations of internal malignan- cy. Adv Dermatol 1986;1:3-42.
8. Çiçek D, Kandi B, Demir B, et al. Primeri Belli Olmayan Bir Karsi- noma Telanjiektatikum. Türkderm 2008;42:70-72.

9. Reichel M, Wheeland RG. Inflammatory carcinoma masquerading as erythema annulare centrifugum. Acta Derm Venereol 1993;73:138- 140.
10. Damin DC, Lazzaron AR, Tarta C, et al. Massive zosteriform cutaneous metastasis from rectal carcinoma. Tech Coloproctol 2003;7:105-107.
11. Ayyamperumal A, Tharini GK, Ravindran V, et al. Cutaneous Mani- festations of Internal Malignancy. Indian J Dermatol 2012;57:260– 264.
12. Mueller TJ, Wu H, Greenberg RE, et al. Cutaneous metastases from genitourinary malignancies. Urology 2004;63:1021–1026.
13. Finan MC, Su WP, Li CY. Cutaneous findings in hairy cell leuke- mia. JAAD 1984;11:788-797.
14. Bell HK, Poston GJ, Vora J, et al. Cutaneous manifestations of the malignant carcinoid syndrome. British Journal of Dermatology 2005;152:71–75.
15. Callen JP, Bernardi DM, Clark RA, et al. Adult-onset recalcitrant eczema: a marker of noncutaneous lymphoma or leukemia. J Am Acad Dermatol 2000;43:207-210.
16. El Tal AK, Tannous Z. Cutaneous Vascular Disorders Associated with Internal Malignancy. Dermatol Clin 2008;26:45-57.