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Cutaneous manifestations of internal malignancy

Cindy Owen, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD


The cutaneous manifestations of internal malignancy include a wide variety of nonmalignant skin disorders that occur in association with malignancy (paraneoplastic dermatoses) and skin disorders that represent infiltration of malignant cells into the skin due to metastatic or locoregional spread of disease or the deposition of circulating tumor cells (eg, leukemia cutis) [1,2]. When paraneoplastic dermatoses develop before an internal neoplasm is diagnosed, recognition of these disorders can aid in the diagnosis of the malignancy.


Paraneoplastic dermatoses are a group of skin disorders that have strong associations with internal malignancies. Curth's postulates can aid in the classification of dermatoses as paraneoplastic (table 1) [1]. Cutaneous findings resulting from the entry of tumor cells into the skin are not considered paraneoplastic dermatoses. (See 'Non-paraneoplastic cutaneous manifestations of internal malignancy' below.)

The paraneoplastic dermatoses reviewed below are organized according to common clinical features. Some of these dermatoses may also develop in the absence of malignancy. However, the detection of a potential paraneoplastic dermatosis warrants consideration of the possibility of malignancy.

Hyperkeratotic and proliferative dermatoses — Acanthosis nigricans, the sign of Leser-Trélat, tripe palm, acquired ichthyosis, and palmoplantar keratoderma are examples of paraneoplastic disorders that present with clinical features of hyperkeratosis or epidermal proliferation.

Acanthosis nigricans — Acanthosis nigricans is a reactive skin pattern that typically presents as velvety to verrucous hyperpigmented plaques in intertriginous areas (picture 1A-D). While the majority of cases of acanthosis nigricans are benign and associated with obesity and insulin resistance, the disease also can herald the onset of malignancy. (See "Acanthosis nigricans".)

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Literature review current through: Nov 2017. | This topic last updated: Jan 11, 2017.
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