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Cutaneous markers of internal malignancy

Skin changes can often be the first sign of a deeper problem including an internal malignancy. Signs of skin disease may precede, occur with, or follow the detection of an associated cancer. These skin diseases can be a feature of an undiagnosed cancer and may be the prompt for a thorough examination in patients. Or in a patient whose cancer is in remission, these skin diseases may be the initial sign of the cancer recurring.

Cutaneous markers can be classified into 2 major types:

• Genetically determined syndromes with a cutaneous component (genodermatoses) that predispose at risk individuals to develop cancer
• Paraneoplastic syndromes which occur as a result of circulating factor(s) or presumed factors produced by the underlying cancer

Genodermatoses

Skin diseases that come under the group of genodermatoses include:

• Cowden's disease
• Gardner syndrome
• Gorlin's syndrome
• Multiple endocrine neoplasm type 2B
• Neurofibromatosis
• Peutz-Jeghers syndrome
• Torre-Muir syndrome
• Progeria (premature aging syndromes)

Paraneoplastic syndromes

Cutaneous paraneoplastic syndromes can be categorised according to the type of lesion they produce.