Florid cutaneous papillomatosis is a rare disease characterised by the rapid onset of numerous warty small papules and larger nodules on the trunk and extremities. The lesions look like viral warts. The term, ‘papillomatosis’ describes numerous papillomas, or little bumps on the skin, for which there are many causes.
Florid cutaneous papillomatosis is always associated with an internal malignancy and often occurs in association with malignant acanthosis nigricans and the sign of Leser-Trelat.
As with malignant acanthosis nigricans and the sign of Leser-Trelat, the cause of florid cutaneous papillomatosis is unknown. It is thought that these three paraneoplastic syndromes are caused by the release of hormones from the tumour but this remains to be proven.
Florid cutaneous papillomatosis is mostly associated with stomach cancer (gastric adenocarcinoma). The signs and symptoms of florid cutaneous papillomatosis are often evident before or at the same time as the diagnosis of the internal malignancy. Other cancers that have occurred with florid cutaneous papillomatosis include other abdominal tumours (such as cancer of the urinary bladder, biliary ducts, ovaries, and uterus), breast cancer, squamous cell cancer of the lungs, and non-Hodgkin lymphoma.
The first sign of florid cutaneous papillomatosis is the eruption of wart-like growths on the trunk and extremities, particularly on the upper surface of the hands and wrist. The lesions then spread to involve the entire body, including the face. The size of the skin lesions can range from anywhere between 2 mm to 1 cm in diameter.
Pruritus (itching) may be experienced before the onset of florid cutaneous papillomatosis and may occur in the affected areas or may be generalised. Pruritus affects about one half of patients with florid cutaneous papillomatosis.
The main concern with regards to the diagnosis of florid cutaneous papillomatosis is distinguishing it from viral warts. Although florid cutaneous papillomatosis may look like viral warts clinically, evaluation of a skin biopsy by a pathologist will clearly distinguish them.
If florid cutaneous papillomatosis is diagnosed, it is extremely important to perform a thorough workup for underlying malignancy and identify a hidden cancer.
The primary aim of treatment is to remove the cancer. Marked improvement of lesions has been reported after surgical treatment or chemotherapy of the cancer.
There is no specific treatment for florid cutaneous papillomatosis. Symptomatic treatments that may be used to improve lesions include topical steroids, oral retinoids, radiation therapy, topical 5-fluorouracil, urea, salicylic acid and liquid nitrogen.
Patients whose cancers are in remission should be monitored for any recurrence of florid cutaneous papillomatosis as this may indicate regrowth or growth of a new tumour.
