Cutaneous Manifestations of Internal Malignancy.

Ayyam Perumal, A (2008) Cutaneous Manifestations of Internal Malignancy. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Skin is a good mirror of internal diseases and gives more diagnostic clues than any other organs of the body. A wide range of cutaneous signs may be related to internal malignancy. Cancer may manifest in the skin as metastasis (e.g., leukemia cutis, cutaneous T-cell lymphoma, Paget's disease of the breast), nonspecific metabolic effects related to inanition (e.g., wasting, alopecia, xerosis), infections related to immunosuppression (e.g., herpes zoster), signs resulting from compromise or dysfunction of the affected organ (e.g., jaundice), or diverse dermatologic entities called paraneoplastic syndromes, which signal that a remote malignancy is present. Cutaneous manifestations may develop before a diagnosis of malignancy is determined; thus, these findings may aid the physician in the early identification of malignancy. It is important to recognize the skin manifestations at the earliest for the following reasons. 1. Their easy accessibility. 2. The skin lesions may be the presenting sign and recognized before the primary tumour. 3. The identification of these skin lesions in a known cancer patient under remission may be the first indication of recurrence. 4. It indirectly implies the prognosis of the internal malignancy2. A great challenge to the clinician is deciding when an aggressive evaluation for an occult malignancy is warranted and when conservative management is appropriate. Approximately 70% of cancers in patients with a presumed paraneoplastic condition can be detected with simple history taking, physical examination, and sexand age-appropriate cancer screening. Unfortunately, most cutaneous paraneoplastic syndromes are associated with unresponsive cancers, and the prognosis is often poor. AIM OF THE STUDY : 1. To study the incidence of Cutaneous Manifestations in patients with internal Malignancy. 2. To study the age & sex predilection of Cutaneous Manifestations in patients with internal Malignancy. 3. To study the incidence of specific and non specific cutaneous manifestations in relation to various internal Malignancies 4. To study the clinical pattern of cutaneous manifestations among patients with internal malignancy. 5. To study the incidence of genodermatoses among patients of internal malignancy with cutaneous manifestations. 6. To study the prognostic significance of the cutaneous manifestations. CONCLUSION : 1. The incidence of Cutaneous Manifestations associated with internal malignancy is 6.93% 2. Out of 52 patients having cutaneous Manifestations with internal Malignancy, 34 patients were Male (65%) and 18 were female (35%). Males and Females above 50 yrs had more cutaneous Manifestations associated with internal Malignancy. 3. The incidence of Cutaneous Metastases in this study was 2.66%, and the incidence of Non-Specific Cutaneous Manifestation was 4.26%. 4. Lymphomas and Leukemias were the commonest neoplasm producing cutaneous manifestations followed by Carcinoma Breast and Carcinoma Stomach. Cutaneous Metastases was the commonest skin manifestation among Malignancy patients followed by Herpes Zoster. Non-Contiguous Metastases was more common in males whereas Contiguous Metastases was more common in females. The period of interval between the onset of symptoms of the primary malignancy and onset of cutaneous metastases ranged from 2 months in a case of AML to 5 years in a case of Carcinoma Breast. Contiguous Cutaneous Metastases was more commonly seen with Carcinoma Breast and Non Hodgkin’s Lymphoma was the commonest neoplasm to produce non-Contiguous Metastases. Skin colored nodule was the commonest clinical presentation of cutaneous metastases and most often occurred in multiple sites, The commonest site of distant Metastases was Chest, followed by abdomen and lower limb. Leukemias had manifested with variety of skin lesions like cutaneous metastases, purpura, pruritus, pyoderma gangrenousm, Systemic lupus erythematosus, herpes Zoster, Varicellosis and exaggerated insect bite allergy lesions. Dissemination, Multidermatomal involvement, longer healing time, tendency for Keloid formation and Post Herpetic Neuralgia was observed in Malignancy patients with Herpes Zoster. 5. Genodermatoses with associated internal malignancy was not noted. 6. Cutaneous metastases indicating recurrence of NHL and Carcinoma Breast, the survival period was 2 months and 6 months respectively. Among cases of Non-Specific cutaneous manifestation, the shortest period of survival was 14 days in a case of HepatoCellular Carcinoma. The prognosis could not be definitely ascertained because of small number of cases studied and the large number of drop outs, but in general Cutaneous Metastases, the Bullous disorders and disseminated Infections had poor prognosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cutaneous Manifestations ; Internal Malignancy.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Jul 2017 02:25
Last Modified: 05 Jul 2017 08:30

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